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In Reply: Dr Wierzbicki and colleagues suggest that inclusion of hsCRP might increase the predictive accuracy of the FRS to a greater extent than CACS. We have examined the relative predictive power of hsCRP and CACS¹ and found that both hsCRP and CACS independently contribute to coronary event prediction. In response to their suggestion to evaluate the predictive ability of hsCRP level in addition to FRS, we calculated the ROC area for a model that includes FRS plus hsCRP level (ROC area = 0.64) and found that this model was not significantly better than FRS alone (ROC area = 0.63, P = .09) and had poorer discrimination than that for FRS plus CACS (ROC area = 0.68, P<.01). In addition, we note that use of risk models combining Framingham risk and hsCRP (or other factors) are neither standard nor widely available at present. However, we agree that they warrant . . . [Full Text of this Article]

Robert C. Detrano, MD, PhD
Department of Medicine
Harbor-UCLA Research and Education Institute
Torrance, Calif

Philip Greenland, MD
Departments of Preventive Medicine and Medicine
Feinberg School of Medicine
Northwestern University
Chicago, Ill

Terence M. Doherty, BA
Division of Cardiology
Cedars-Sinai Medical Center
Los Angeles, Calif

Stanley P. Azen, PhD; Laurie LaBree, MS
Department of Preventive Medicine
Keck School of Medicine
University of Southern California
Los Angeles

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