Skip to main content

Advertisement

SpringerLink
Log in

The Heinz Nixdorf Recall Study and Its Potential Impact on the Adoption of Atherosclerosis Imaging in European Primary Prevention Guidelines

  • Published:
Current Atherosclerosis Reports Aims and scope Submit manuscript

Abstract

Non–contrast-enhanced computed tomography (CT) imaging of the heart enables noninvasive quantification of coronary artery calcification (CAC), a surrogate marker of the atherosclerotic burden in the coronary artery tree. Multiple studies have underlined the ability of CAC score for individual risk stratification and, accordingly, the American Heart Association recommended cardiac CT for risk assessment in individuals with an intermediate risk of cardiovascular events as measured by Framingham Risk Score. However, limitations in transcribing risk stratification algorithms based on American cohort studies into European populations have been acknowledged in the past. Moreover, data on implications for reclassification into higher- or lower-risk groups based on CAC scores were lacking. The Heinz Nixdorf Recall (HNR) study is a population-based cohort study that investigated the ability of CAC scoring in risk prediction for major cardiovascular events above and beyond traditional cardiovascular risk factors. According to Heinz Nixdorf Recall findings, CAC can be used for reclassification, especially in those in the intermediate-risk group, to advise on lifestyle changes for the reclassified low-risk category, or to implement intensive treatments for the reclassified high-risk individuals. This article discusses the present findings of the Heinz Nixdorf Recall Study with respect to the current literature, risk stratification algorithms, and current European guidelines for risk prediction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Raggi P, Callister TQ, Cooil B, et al. Identification of patients at increased risk of first unheralded acute myocardial infarction by electron-beam computed tomography. Circulation. 2000;101:850–5.

    PubMed  CAS  Google Scholar 

  2. Greenland P, LaBree L, Azen SP, Doherty TM, Detrano RC. Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. JAMA. 2004;291:210–5.

    Article  PubMed  CAS  Google Scholar 

  3. •• Erbel R, Mohlenkamp S, Moebus S, et al. Coronary risk stratification, discrimination, and reclassification improvement based on quantification of subclinical coronary atherosclerosis: the Heinz Nixdorf Recall study. J Am Coll Cardiol. 2010;56:1397–406. This article shows the clinical value of CAC quantification in a European population-based cohort study.

    Article  PubMed  Google Scholar 

  4. Detrano R, Guerci AD, Carr JJ, et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med. 2008;358:1336–45.

    Article  PubMed  CAS  Google Scholar 

  5. Greenland P, Bonow RO, Brundage BH, et al. ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain: a report of the American College of Cardiology Foundation Clinical Expert Consensus Task Force (ACCF/AHA Writing Committee to Update the 2000 Expert Consensus Document on Electron Beam Computed Tomography). Circulation. 2007;115:402–26.

    Article  PubMed  Google Scholar 

  6. Graham I, Atar D, Borch-Johnsen K, et al. European guidelines on cardiovascular disease prevention in clinical practice: executive summary. Fourth Joint Task Force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts). Eur J Cardiovasc Prev Rehabil. 2007;14 Suppl 2:E1–40.

    Article  PubMed  Google Scholar 

  7. Roger VL, Go AS, Lloyd-Jones DM, et al. Heart disease and stroke statistics–2011 update: a report from the American Heart Association. Circulation. 2011;123:e18–e209.

    Article  PubMed  Google Scholar 

  8. Dudas K, Lappas G, Stewart S, Rosengren A. Trends in out-of-hospital deaths due to coronary heart disease in Sweden (1991 to 2006). Circulation 123:46–52.

  9. Falk E, Shah PK, Fuster V. Coronary plaque disruption. Circulation. 1995;92:657–71.

    PubMed  CAS  Google Scholar 

  10. Kannel WB, Dawber TR, Kagan A, Revotskie N, Stokes 3rd J. Factors of risk in the development of coronary heart disease–six year follow-up experience. The Framingham Study. Ann Intern Med. 1961;55:33–50.

    PubMed  CAS  Google Scholar 

  11. Ford I, Murray H, Packard CJ, Shepherd J, Macfarlane PW, Cobbe SM. Long-term follow-up of the West of Scotland Coronary Prevention Study. N Engl J Med. 2007;357:1477–86.

    Article  PubMed  CAS  Google Scholar 

  12. Shah T, Swerdlow D. Detecting, predicting and modifying cardiovascular risk: new and developing strategies. Expert Rev Cardiovasc Ther. 2010;8:1519–21.

    Article  PubMed  Google Scholar 

  13. Brindle P, Emberson J, Lampe F, et al. Predictive accuracy of the Framingham coronary risk score in British men: prospective cohort study. BMJ. 2003;327:1267.

    Article  PubMed  Google Scholar 

  14. Mohlenkamp S, Bose D, Mahabadi AA, Heusch G, Erbel R. On the paradox of exercise: coronary atherosclerosis in an apparently healthy marathon runner. Nat Clin Pract Cardiovasc Med. 2007;4:396–401.

    Article  PubMed  Google Scholar 

  15. Akosah KO, Schaper A, Cogbill C, Schoenfeld P. Preventing myocardial infarction in the young adult in the first place: how do the National Cholesterol Education Panel III guidelines perform? J Am Coll Cardiol. 2003;41:1475–9.

    Article  PubMed  Google Scholar 

  16. Rumberger JA, Simons DB, Fitzpatrick LA, Sheedy PF, Schwartz RS. Coronary artery calcium area by electron-beam computed tomography and coronary atherosclerotic plaque area. A histopathologic correlative study. Circulation. 1995;92:2157–62.

    PubMed  CAS  Google Scholar 

  17. Baumgart D, Schmermund A, Goerge G, et al. Comparison of electron beam computed tomography with intracoronary ultrasound and coronary angiography for detection of coronary atherosclerosis. J Am Coll Cardiol. 1997;30:57–64.

    Article  PubMed  CAS  Google Scholar 

  18. Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte Jr M, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 1990;15:827–32.

    Article  PubMed  CAS  Google Scholar 

  19. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Final Report. NIH Publication No. 02–5215. 2002 Sep.

  20. Kondos GT, Hoff JA, Sevrukov A, et al. Electron-beam tomography coronary artery calcium and cardiac events: a 37-month follow-up of 5635 initially asymptomatic low- to intermediate-risk adults. Circulation. 2003;107:2571–6.

    Article  PubMed  Google Scholar 

  21. Shaw LJ, Raggi P, Schisterman E, Berman DS, Callister TQ. Prognostic value of cardiac risk factors and coronary artery calcium screening for all-cause mortality. Radiology. 2003;228:826–33.

    Article  PubMed  Google Scholar 

  22. Vliegenthart R, Oudkerk M, Hofman A, et al. Coronary calcification improves cardiovascular risk prediction in the elderly. Circulation. 2005;112:572–7.

    Article  PubMed  Google Scholar 

  23. Arad Y, Goodman KJ, Roth M, Newstein D, Guerci AD. Coronary calcification, coronary disease risk factors, C-reactive protein, and atherosclerotic cardiovascular disease events: the St. Francis Heart Study. J Am Coll Cardiol. 2005;46:158–65.

    Article  PubMed  CAS  Google Scholar 

  24. Blaha M, Budoff MJ, Shaw LJ, et al. Absence of coronary artery calcification and all-cause mortality. JACC Cardiovasc Imaging. 2009;2:692–700.

    Article  PubMed  Google Scholar 

  25. Tsang TS, Abhayaratna WP, Barnes ME, et al. Prediction of cardiovascular outcomes with left atrial size: is volume superior to area or diameter? J Am Coll Cardiol. 2006;47:1018–23.

    Article  PubMed  Google Scholar 

  26. Mahabadi AA, Truong QA, Schlett CL, et al. Axial area and anteroposterior diameter as estimates of left atrial size using computed tomography of the chest: comparison with 3-dimensional volume. J Cardiovasc Comput Tomogr 4:49–54

  27. Mahabadi AA, Massaro JM, Rosito GA, et al. Association of pericardial fat, intrathoracic fat, and visceral abdominal fat with cardiovascular disease burden: the Framingham Heart Study. Eur Heart J. 2009;30:850–6.

    Article  PubMed  Google Scholar 

  28. De Backer G, Ambrosioni E, Borch-Johnsen K, et al. European guidelines on cardiovascular disease prevention in clinical practice: third joint task force of European and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of eight societies and by invited experts). Eur J Cardiovasc Prev Rehabil. 2003;10:S1–S10.

    Article  PubMed  Google Scholar 

  29. Schmermund A, Mohlenkamp S, Stang A, et al. Assessment of clinically silent atherosclerotic disease and established and novel risk factors for predicting myocardial infarction and cardiac death in healthy middle-aged subjects: rationale and design of the Heinz Nixdorf RECALL Study. Risk Factors, Evaluation of Coronary Calcium and Lifestyle. Am Heart J. 2002;144:212–8.

    Article  PubMed  Google Scholar 

  30. Schmermund A, Lehmann N, Bielak LF, et al. Comparison of subclinical coronary atherosclerosis and risk factors in unselected populations in Germany and US-America. Atherosclerosis. 2007;195:e207–216.

    Article  PubMed  CAS  Google Scholar 

  31. Erbel R, Mohlenkamp S, Lehmann N, et al. Sex related cardiovascular risk stratification based on quantification of atherosclerosis and inflammation. Atherosclerosis. 2008;197:662–72.

    Article  PubMed  CAS  Google Scholar 

  32. • Jockel KH, Lehmann N, Jaeger BR, et al. Smoking cessation and subclinical atherosclerosis–results from the Heinz Nixdorf Recall Study. Atherosclerosis. 2009;203:221–7. This article shows the association of smoking cessation and presence of subclinical atherosclerosis as a result from the Heinz Nixdorf Recall Study.

    Article  PubMed  Google Scholar 

  33. Hoffmann B, Moebus S, Mohlenkamp S, et al. Residential exposure to traffic is associated with coronary atherosclerosis. Circulation. 2007;116:489–96.

    Article  PubMed  CAS  Google Scholar 

  34. Dragano N, Verde PE, Moebus S, et al. Subclinical coronary atherosclerosis is more pronounced in men and women with lower socio-economic status: associations in a population-based study. Coronary atherosclerosis and social status. Eur J Cardiovasc Prev Rehabil. 2007;14:568–74.

    Article  PubMed  Google Scholar 

  35. Stang A, Dragano N, Poole C, et al. Daily siesta, cardiovascular risk factors, and measures of subclinical atherosclerosis: results of the Heinz Nixdorf Recall Study. Sleep. 2007;30:1111–9.

    PubMed  Google Scholar 

  36. Erbel R, Delaney JA, Lehmann N, et al. Signs of subclinical coronary atherosclerosis in relation to risk factor distribution in the Multi-Ethnic Study of Atherosclerosis (MESA) and the Heinz Nixdorf Recall Study (HNR). Eur Heart J. 2008;29:2782–91.

    Article  PubMed  Google Scholar 

  37. • Möhlenkamp S, Lehmann N, Moebus S, et al. Quantification of coronary atherosclerosis and inflammation to predict coronary events and all-cause mortality. J Am Coll Cardiol. 57:1455–1464. This article describes the role of CAC and markers of systemic inflammation for risk assessment in general population.

  38. • Möhlenkamp S, Lehmann N, Greenland P, et al. Coronary artery calcium score improves cardiovascular risk prediction in persons without indication for statin therapy. Atherosclerosis 215:229–236. This article describes the clinical significance of CAC in low-risk cohorts.

Download references

Disclosure

No conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

  1. Department of Cardiology, West-German Heart Center Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany

    Amir A. Mahabadi, Stefan Möhlenkamp, Hagen Kälsch, Marcus Bauer & Raimund Erbel

  2. Institute of Medical Informatics, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany

    Susanne Moebus, Nico Dragano & Karl-Heinz Jöckel

Authors
  1. Amir A. Mahabadi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stefan Möhlenkamp
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Susanne Moebus
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nico Dragano
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hagen Kälsch
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marcus Bauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Karl-Heinz Jöckel
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Raimund Erbel
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

on behalf of the Heinz Nixdorf Investigator Group

Corresponding author

Correspondence to Raimund Erbel.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mahabadi, A.A., Möhlenkamp, S., Moebus, S. et al. The Heinz Nixdorf Recall Study and Its Potential Impact on the Adoption of Atherosclerosis Imaging in European Primary Prevention Guidelines. Curr Atheroscler Rep 13, 367–372 (2011). https://doi.org/10.1007/s11883-011-0199-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11883-011-0199-7

Keywords

Search

Navigation