Development of a DXA-Based Risk Score for Cardiovascular Outcomes Among Older Adults: The Health, Aging, and Body Composition Study

Abstract

Abstract Cardiovascular disease (CVD) is the leading cause of death worldwide and its risk factors have long been investigating in epidemiological studies. Although the Framingham Risk Score provided an estimate for cardiovascular risk, it did not utilize the body compositions biomarkers. Therefore, our study aims to develop a body composition-based score and incorporate the score into the FRS for better predicting cardiovascular disease among initially well-functioning older adults. 1,882 older adults in the Health, Aging and Body Composition (Health ABC) study were included in our study to screen body composition variables obtained from the Dual-energy X-ray absorptiometry (DXA). We developed the 4-DXA risk score model from the selected variables, refitted the Framingham Risk Score (FRS), incorporated the 4-DXA risk score into the FRS, and compared these developed prediction models. C-statistics were 0.58, 0.62, and 0.63 respectively. Compared to the refit FRS, the net reclassification index and the integrated discrimination index was 0.012 (95% CI: 0.0068–0.018) and 0.12 (95% CI = 0.021, 0.22) for the refit FRS plus the 4-DXA model. Inclusion of body composition indices slightly improved the model performance for predicting CVD. Further research is needed to validate the score accuracy in a higher-risk population.