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Comparative Study
. 2013 Mar 26;61(12):1231-9.
doi: 10.1016/j.jacc.2012.12.035.

Progression of coronary calcium and incident coronary heart disease events: MESA (Multi-Ethnic Study of Atherosclerosis)

Matthew J Budoff  1 , Rebekah Young, Victor A Lopez, Richard A Kronmal, Khurram Nasir, Roger S Blumenthal, Robert C Detrano, Diane E Bild, Alan D Guerci, Kiang Liu, Steven Shea, Moyses Szklo, Wendy Post, Joao Lima, Alain Bertoni, Nathan D Wong
Affiliations
Comparative Study

Progression of coronary calcium and incident coronary heart disease events: MESA (Multi-Ethnic Study of Atherosclerosis)

Matthew J Budoff et al. J Am Coll Cardiol. .

Abstract

Objectives: The study examined whether progression of coronary artery calcium (CAC) is a predictor of future coronary heart disease (CHD) events.

Background: CAC predicts CHD events and serial measurement of CAC has been proposed to evaluate atherosclerosis progression.

Methods: We studied 6,778 persons (52.8% female) aged 45 to 84 years from the MESA (Multi-Ethnic Study of Atherosclerosis) study. A total of 5,682 persons had baseline and follow-up CAC scans approximately 2.5 ± 0.8 years apart; multiple imputation was used to account for the remainder (n = 1,096) missing follow-up scans. Median follow-up duration from the baseline was 7.6 (max = 9.0) years. CAC change was assessed by absolute change between baseline and follow-up CAC. Cox proportional hazards regression providing hazard ratios (HRs) examined the relation of change in CAC with CHD events, adjusting for age, gender, ethnicity, baseline calcium score, and other risk factors.

Results: A total of 343 and 206 hard CHD events occurred. The annual change in CAC averaged 24.9 ± 65.3 Agatston units. Among persons without CAC at baseline (n = 3,396), a 5-unit annual change in CAC was associated with an adjusted HR (95% Confidence Interval) of 1.4 (1.0 to 1.9) for total and 1.5 (1.1 to 2.1) for hard CHD. Among those with CAC >0 at baseline, HRs (per 100 unit annual change) were 1.2 (1.1 to 1.4) and 1.3 (1.1 to 1.5), respectively. Among participants with baseline CAC, those with annual progression of ≥300 units had adjusted HRs of 3.8 (1.5 to 9.6) for total and 6.3 (1.9 to 21.5) for hard CHD compared to those without progression.

Conclusions: Progression of CAC is associated with an increased risk for future hard and total CHD events.

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Figures

Figure 1
Figure 1
Kaplan-Meier Plot of Cumulative Incidence of Total CHD Among Persons with CAC=0 at Baseline; p<.001 for log-rank test for equality of survivor function comparing those with any vs. no change in CAC. Numbers in parenthesis indicate the proportion of subjects in each group. Both imputed and nonimputed subjects are included. CAC=coronary artery calcium; CHD=coronary heart disease.
Figure 2
Figure 2
Kaplan-Meier Plot of Cumulative Incidence of Total CHD Among Persons with CAC>0 at Baseline; p<0.001 for log-rank test for equality of survivor function across CAC change groups: 300+, 200–299, 100–199, 0.001–100, negative or no change. Numbers in parenthesis indicate the proportion of subjects in each group. Both imputed and nonimputed subjects are included. CAC=coronary artery calcium; CHD=coronary heart disease
See this image and copyright information in PMC

References

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