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

Among 13 negative risk markers, a coronary artery calcium score of zero was the strongest for ruling out future coronary heart disease events over 10 years, resulting in a mean 59% relative reduction

Effect: improvement; DLR 0.41 (SD 0.12) for all CHD; DLR 0.36 (0.09) in men, 0.46 (0.12) in women

A coronary artery calcium score of zero was the strongest negative risk marker for ruling out future cardiovascular disease events over 10 years, resulting in a mean 46% relative reduction in pre-test

Effect: improvement; DLR 0.54 (SD 0.12) for CVD; DLR 0.49 (0.10) in men, 0.59 (0.12) in women

CAC=0 resulted in the largest and most accurate downward risk reclassification among all 13 negative risk markers, consistently regardless of the risk threshold definition used.

Effect: improvement; largest, most accurate downward risk reclassification among all 13 markers

Low carotid intima-media thickness (below the 25th percentile) was the second-strongest negative risk marker after CAC=0, providing moderate downgrading of CHD and CVD risk after adjustment for tradit

Effect: improvement; DLR 0.65 (SD 0.04) for all CHD; DLR 0.75 (SD 0.04) for CVD

A normal hsCRP level (<2 mg/L) performed poorly as a negative risk marker, providing minimal post-test risk change for both CHD and CVD events, regardless of the cutpoint chosen.

Effect: null; DLR >0.80 for both CHD and CVD

A normal ankle-brachial index (0.9-1.3) performed poorly as a negative risk marker, providing minimal post-test risk change, despite being the most prevalent negative result (93% of participants).

Effect: null; DLR >0.80 for CVD

Among clinical features (as opposed to imaging or lab tests), absence of any family history of coronary heart disease was the strongest negative risk marker, providing moderate downgrading of CHD and

Effect: improvement; DLR 0.76 (SD 0.07) for all CHD; DLR 0.81 (SD 0.06) for CVD