{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T22:30:31Z","timestamp":1790375431808,"version":"4.1.0"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2016,2,23]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              We determined whether vascular and valvular calcification predicted incident major coronary heart disease, cardiovascular disease (\n              <jats:styled-content style=\"fixed-case\">CVD<\/jats:styled-content>\n              ), and all\u2010cause mortality independent of Framingham risk factors in the community\u2010based Framingham Heart Study.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Coronary artery calcium (\n              <jats:styled-content style=\"fixed-case\">CAC<\/jats:styled-content>\n              ), thoracic and abdominal aortic calcium, and mitral or aortic valve calcium were measured by cardiac computed tomography in participants free of\n              <jats:styled-content style=\"fixed-case\">CVD<\/jats:styled-content>\n              . Participants were followed for a median of 8\u00a0years. Multivariate Cox proportional hazards models were used to determine association of\n              <jats:styled-content style=\"fixed-case\">CAC<\/jats:styled-content>\n              , thoracic and abdominal aortic calcium, and mitral and aortic valve calcium with end points. Improvement in discrimination beyond risk factors was tested via the C\u2010statistic and net reclassification index. In this cohort of 3486 participants (mean age 50\u00b110 years; 51% female),\n              <jats:styled-content style=\"fixed-case\">CAC<\/jats:styled-content>\n              was most strongly associated with major coronary heart disease, followed by major\n              <jats:styled-content style=\"fixed-case\">CVD<\/jats:styled-content>\n              , and all\u2010cause mortality independent of Framingham risk factors. Among noncoronary calcifications, mitral valve calcium was associated with major\n              <jats:styled-content style=\"fixed-case\">CVD<\/jats:styled-content>\n              and all\u2010cause mortality independent of Framingham risk factors and\n              <jats:styled-content style=\"fixed-case\">CAC<\/jats:styled-content>\n              .\n              <jats:styled-content style=\"fixed-case\">CAC<\/jats:styled-content>\n              significantly improved discriminatory value beyond risk factors for coronary heart disease (area under the curve 0.78\u20130.82; net reclassification index 32%, 95%\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              11\u201353) but not for\n              <jats:styled-content style=\"fixed-case\">CVD<\/jats:styled-content>\n              .\n              <jats:styled-content style=\"fixed-case\">CAC<\/jats:styled-content>\n              accurately reclassified 85% of the 261 patients who were at intermediate (5\u201310%) 10\u2010year risk for coronary heart disease based on Framingham risk factors to either low risk (n=172; no events observed) or high risk (n=53; observed event rate 8%).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              <jats:styled-content style=\"fixed-case\">CAC<\/jats:styled-content>\n              improves discrimination and risk reclassification for major coronary heart disease and\n              <jats:styled-content style=\"fixed-case\">CVD<\/jats:styled-content>\n              beyond risk factors in asymptomatic community\u2010dwelling persons and accurately reclassifies two\u2010thirds of the intermediate\u2010risk population.\n            <\/jats:p>\n          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