Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2009 Jan 1;103(1):59-63.
doi: 10.1016/j.amjcard.2008.08.031. Epub 2008 Oct 17.

Arterial age as a function of coronary artery calcium (from the Multi-Ethnic Study of Atherosclerosis [MESA])

Affiliations
Comparative Study

Arterial age as a function of coronary artery calcium (from the Multi-Ethnic Study of Atherosclerosis [MESA])

Robyn L McClelland et al. Am J Cardiol. .

Abstract

It has been proposed that coronary artery calcium (CAC) can be used to estimate arterial age in adults. Supporting this concept is that chronologic age, as used in cardiovascular risk assessment, is a surrogate for atherosclerotic burden. This measure can provide patients with a more understandable version of their CAC scores (e.g., "You are 55 years old, but your arteries are more consistent with an arterial age of 65 years"). The aim of this study was to describe a method of calculating arterial age by equating estimated coronary heart disease (CHD) risk for observed age and CAC. Arterial age is then the risk equivalent of CAC. Data from the Multi-Ethnic Study of Atherosclerosis (MESA), a cohort study of 6,814 participants free of clinical cardiovascular disease and followed for an average of 4 years, were used. Estimated arterial age was obtained as a simple linear function of log-transformed CAC. In a model for incident CHD risk controlling for age and arterial age, only arterial age was significant, indicating that observed age does not provide additional information after controlling for arterial age. Framingham risk calculated using this arterial age was more predictive of short-term incident coronary events than Framingham risk on the basis of observed age (area under the receiver-operating characteristic curve 0.75 for Framingham risk on the basis of observed age and 0.79 using arterial age, p = 0.006). In conclusion, arterial age provides a convenient transformation of CAC from Agatston units to a scale more easily appreciated by patients and treating physicians.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Estimated Arterial Age and 95% Confidence Bands by Coronary Artery Calcium
The estimated arterial age with 95% confidence bands is displayed for each CAC score. CAC is displayed on the log scale, but labeled in original units for ease of use. A person with a CAC score of 10 Agatston units has an estimated arterial age of approximately 56, while a CAC score of 400 yields an arterial age of 83.
Figure 2
Figure 2. Arterial Age Minus Observed Age by Coronary Artery Calcium
For each participant this plot displays the difference between their estimated arterial age and their observed chronologic age. A negative difference indicates that their arterial age is less than their chronologic age (e.g. older participants who are free of CAC). A positive difference indicates that their arterial age is greater than their chronologic age. CAC is displayed on the log scale, but labeled in original units for ease of use.
Figure 3
Figure 3. Estimated Framingham Risk Using Chronologic Age Minus Estimated Risk Using Arterial Age Versus Coronary Artery Calcium
For each participant this plot displays the difference between their 10-year Framingham risk calculated using their arterial age and that calculated using their chronologic age. A negative difference indicates that their 10-year CHD risk based on arterial age is less than what would be estimated given their chronologic age (e.g. older participants who are free of CAC). A positive difference indicates that their estimated 10-year risk using arterial age is greater than that using their chronologic age. CAC is displayed on the log scale, but labeled in original units for ease of use.
Figure 4
Figure 4. Receiver-Operator Characteristic (ROC) Curve for Incident CHD Using Framingham Risk Based on Chronologic Age and Based on Arterial Age
Each curve indicates the ability of the predictor to discriminate between incident CHD cases and non-cases. Better discrimination is indicated by curves which are closer to the upper left hand corner, where both sensitivity and specificity are high. Random assignment, as in a coin toss, would fall along the straight line. The curve for Framingham risk score calculated using arterial age rather than chronologic age is higher, indicating better discrimination between CHD cases and non-cases.

Comment in

References

    1. Stein JH, Fraizer MC, Aeschlimann SE, Nelson-Worel J, McBride PE, Douglas PS. Vascular age: integrating carotid intima-media thickness measurements with global coronary risk assessment. Clin Cardiol. 2004;27(7):388–392. - PMC - PubMed
    1. Schisterman EF, Whitcomb BW. Coronary age as a risk factor in the modified Framingham risk score. BMC Med Imaging. 2004;26(41):1. - PMC - PubMed
    1. Shaw LJ, Raggi P, Berman DS, Callister TQ. Coronary artery calcium as a measure of biologic age. Atherosclerosis. 2006;188:112–119. - PubMed
    1. Nasir K, Vasamreddy C, Blumenthal RS, Rumberger JA. Comprehensive coronary risk determination in primary prevention: An imaging and clinical based definition combining computed tomographic coronary artery calcium score and national cholesterol education program risk score. Int J Cardiol. 2006;110:129–136. - PubMed
    1. Sirineni GKR, Raggi P, Shaw LJ, Stillman AE. Calculation of coronary age using calcium scores in multiple ethnicities. Int J Cardiovasc Imaging. 2008;24(10):107–111. - PubMed

Publication types

MeSH terms