Abstract 13128: Self-Rated Health, Coronary Artery Calcium Scores, and Atherosclerotic Cardiovascular Disease Risk:The Multi-Ethnic Study of Atherosclerosis.

Introduction: The interplay of self-rated health (SRH), Coronary Artery Calcium (CAC) and ASCVD risk is poorly described. We assessed the correlation between SRH and CAC, and whether the combination of SRH and CAC offers similar risk discrimination to established risk scores. Methods: We included 6,764 participants of the Multi-Ethnic Study of Atherosclerosis. SRH was classified as Poor/Fair, Good, Very Good or Excellent. CAC scores were handled in categorical and log-transformed continuous forms. ASCVD risk scores were derived using the Pooled Cohort Equations. Participants were followed over a median of 13.2 years for hard coronary heart disease (CHD) and cardiovascular disease (CVD) events, and all-cause death. We assessed the association of SRH with risk factors and CAC. We then assessed the predictive value of SRH, using Cox regression models sequentially adjusted for age, gender, race/ethnicity; CAC; and risk factors. Similarly, we assessed the predictive value of CAC in the excellent SRH group. Finally, we assessed improvements in risk discrimination on adding SRH to CAC, and compared the discriminatory value of the combination of SRH and CAC to that of the ASCVD risk score. Results: Mean [SD] age was 62.1 [10.2] years, with 47% men. SRH was strongly associated with age, sex, race/ethnicity, healthy diet, physical activity, and cardiovascular risk factors. There was no correlation (r= -0.007, p= 0.57) or association between SRH and the presence or severity of CAC. In models adjusted for age, gender, race/ethnicity, and CAC, those who reported excellent health had 45% lower risk of CVD (HR 0.55, 95% CI 0.39 - 0.77) and 42% lower risk of CHD (HR 0.58, 95% CI 0.37 - 0.90) compared to those who reported Poor/Fair health. CAC was however predictive of risk in all SRH groups, including the excellent SRH group. The addition of SRH to CAC improved ROC c-statistics for all tested outcomes. A comparison of SRH plus CAC vs ASCVD risk score showed similar CHD (0.734 vs 0.712, p=0.09) and CVD (0.706 vs 0.717, p=0.31) risk discrimination. Conclusion: While SRH and CAC similarly integrate risk variables, they are poorly correlated and have predictive utility independent of each other. A simple combination of these measures can be complementary for risk prediction, with similar risk discrimination to the ASCVD risk score. [ABSTRACT FROM AUTHOR]