Role of Coronary Artery Calcium Score of Zero and Other Negative Risk Markers for Cardiovascular Disease: the Multi-Ethnic Study of Atherosclerosis (MESA)

Michael J. Blaha, Miguel Cainzos-Achirica, Philip Greenland, John W. McEvoy, Ron Blankstein, Matthew J. Budoff, Zeina Dardari, Christopher Sibley, Gregory L. Burke, Richard A. Kronmal, Moyses Szklo, Roger S. Blumenthal, Khurram Nasir

Research output: Contribution to journalArticle

131 Scopus citations


Limited attention has been paid to negative cardiovascular disease (CVD) risk markers despite their potential to improve medical decision making. We compared 13 negative risk markers using diagnostic likelihood ratios (DLRs), which model the change in risk for an individual after the result of an additional test. Methods and Results-We examined 6814 participants from the Multi-Ethnic Study of Atherosclerosis. Coronary artery calcium score of 0, carotid intima-media thickness <25th percentile, absence of carotid plaque, brachial flow-mediated dilation > 5% change, ankle-brachial index > 0.9 and 0.80. Among clinical features, absence of any family history of coronary heart disease was the strongest (DLRs, 0.76 [SD, 0.07] and 0.81 [SD, 0.06], respectively). Net reclassification improvement analyses yielded similar findings, with coronary artery calcium score of 0 resulting in the largest, most accurate downward risk reclassification. Conclusions-Negative results of atherosclerosis-imaging tests, particularly coronary artery calcium score of 0, resulted in the greatest downward shift in estimated CVD risk. These results may help guide discussions on the identification of individuals less likely to receive net benefit from lifelong preventive pharmacotherapy.

Original languageEnglish (US)
Pages (from-to)849-858
Number of pages10
Issue number9
Publication statusPublished - Mar 1 2016



  • Biomarkers
  • calcium
  • cardiac imaging techniques
  • cardiovascular diseases
  • risk assessment

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

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