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Multicenter Study
. 2014 Jul;34(7):1574-9.
doi: 10.1161/ATVBAHA.114.303268. Epub 2014 May 8.

Abdominal aortic calcium, coronary artery calcium, and cardiovascular morbidity and mortality in the Multi-Ethnic Study of Atherosclerosis

Michael H Criqui  1 , Julie O Denenberg  2 , Robyn L McClelland  2 , Matthew A Allison  2 , Joachim H Ix  2 , Alan Guerci  2 , Kevin P Cohoon  2 , Preethi Srikanthan  2 , Karol E Watson  2 , Nathan D Wong  2
Affiliations
Multicenter Study

Abdominal aortic calcium, coronary artery calcium, and cardiovascular morbidity and mortality in the Multi-Ethnic Study of Atherosclerosis

Michael H Criqui et al. Arterioscler Thromb Vasc Biol. 2014 Jul.

Erratum in

  • Correction.
    [No authors listed] [No authors listed] Arterioscler Thromb Vasc Biol. 2015 Jan;35(1):e1. doi: 10.1161/ATV.0000000000000014. Arterioscler Thromb Vasc Biol. 2015. PMID: 30525947 No abstract available.

Abstract

Objective: To evaluate the predictive value of abdominal aortic calcium (AAC) for incident cardiovascular disease (CVD) independent of coronary artery calcium (CAC).

Approach and results: We evaluated the association of AAC with CVD in 1974 men and women aged 45 to 84 years randomly selected from the Multi-Ethnic Study of Atherosclerosis participants who had complete AAC and CAC data from computed tomographic scans. AAC and CAC were each divided into following 3 percentile categories: 0 to 50th, 51st to 75th, and 76th to 100th. During a mean of 5.5 years of follow-up, there were 50 hard coronary heart disease events, 83 hard CVD events, 30 fatal CVD events, and 105 total deaths. In multivariable-adjusted Cox models including both AAC and CAC, comparing the fourth quartile with the ≤ 50th percentile, AAC and CAC were each significantly and independently predictive of hard coronary heart disease and hard CVD, with hazard ratios ranging from 2.4 to 4.4. For CVD mortality, the hazard ratio was highly significant for the fourth quartile of AAC, 5.9 (P=0.01), whereas the association for the fourth quartile of CAC (hazard ratio, 2.1) was not significant. For total mortality, the fourth quartile hazard ratio for AAC was 2.7 (P=0.001), and for CAC, it was 1.9, P=0.04. Area under the receiver operating characteristic curve analyses showed improvement for both AAC and CAC separately, although improvement was greater with CAC for hard coronary heart disease and hard CVD, and greater with AAC for CVD mortality and total mortality. Sensitivity analyses defining AAC and CAC as continuous variables mirrored these results.

Conclusions: AAC and CAC predicted hard coronary heart disease and hard CVD events independent of one another. Only AAC was independently related to CVD mortality, and AAC showed a stronger association than CAC with total mortality.

Keywords: aortic diseases; calcium; cardiovascular diseases; diagnostic imaging; epidemiology.

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Conflict of interest statement

Disclosures

N. Wong is a Consultant (significant) at Re-Engineering Healthcare, Inc. The other authors report no conflicts.

Figures

Figure
Figure
Kaplan–Meier curves for abdominal aortic calcium (AAC) and coronary artery calcium (CAC) categories and time to (A) a coronary heart disease (CHD) event, (B) a cardiovascular disease (CVD) event, (C) a CVD death, and (D) all mortality.
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