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Clinical Trial
. 2008 Jun 23;168(12):1333-9.
doi: 10.1001/archinte.168.12.1333.

Coronary artery calcification compared with carotid intima-media thickness in the prediction of cardiovascular disease incidence: the Multi-Ethnic Study of Atherosclerosis (MESA)

Aaron R Folsom  1 , Richard A Kronmal, Robert C Detrano, Daniel H O'Leary, Diane E Bild, David A Bluemke, Matthew J Budoff, Kiang Liu, Steven Shea, Moyses Szklo, Russell P Tracy, Karol E Watson, Gregory L Burke
Affiliations
Clinical Trial

Coronary artery calcification compared with carotid intima-media thickness in the prediction of cardiovascular disease incidence: the Multi-Ethnic Study of Atherosclerosis (MESA)

Aaron R Folsom et al. Arch Intern Med. .

Erratum in

  • Arch Intern Med. 2008 Sep 8;168(16):1782

Abstract

Background: Coronary artery calcium (CAC) and carotid intima-media thickness (IMT) are noninvasive measures of atherosclerosis that consensus panels have recommended as possible additions to risk factor assessment for predicting the probability of cardiovascular disease (CVD) occurrence. Our objective was to assess whether maximum carotid IMT or CAC (Agatston score) is the better predictor of incident CVD.

Methods: A prospective cohort study of subjects aged 45 to 84 years in 4 ethnic groups, who were initially free of CVD (n = 6698) was performed, with standardized carotid IMT and CAC measures at baseline, in 6 field centers of the Multi-Ethnic Study of Atherosclerosis (MESA). The main outcome measure was the risk of incident CVD events (coronary heart disease, stroke, and fatal CVD) over a maximum of 5.3 years of follow-up.

Results: There were 222 CVD events during follow-up. Coronary artery calcium was associated more strongly than carotid IMT with the risk of incident CVD. After adjustment for each other (CAC score and IMT) and age, race, and sex [corrected], the hazard ratio of CVD increased 2.1-fold (95% confidence interval [CI], 1.8-2.5) for each 1-standard deviation (SD) increment of log-transformed CAC score, vs 1.3-fold (95% CI, 1.1-1.4) for each 1-SD increment of the maximum IMT. For coronary heart disease, the hazard ratios per 1-SD increment increased 2.5-fold (95% CI, 2.1-3.1) for CAC score and 1.2-fold (95% CI, 1.0-1.4) for IMT. A receiver operating characteristic curve analysis also suggested that CAC score was a better predictor of incident CVD than was IMT, with areas under the curve of 0.81 vs 0.78, respectively.

Conclusion: Although whether and how to clinically use bioimaging tests of subclinical atherosclerosis remains a topic of debate, this study found that CAC score is a better predictor of subsequent CVD events than carotid IMT.

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Figures

Figure 1
Figure 1
Unadjusted Rate and 95 Percent Confidence interval of Cardiovascular Disease in Relation to Percentiles of Maximal Carotid Intima-Media Thickness (IMT) or Coronary Artery Calcium (CAC), MESA, 2000–2004
See this image and copyright information in PMC

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