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Multicenter Study
. 2014 Nov;7(11):1108-15.
doi: 10.1016/j.jcmg.2014.07.009. Epub 2014 Nov 10.

Coronary artery calcium and incident cerebrovascular events in an asymptomatic cohort. The MESA Study

Ashleigh O Gibson  1 , Michael J Blaha  2 , Martinson K Arnan  3 , Ralph L Sacco  4 , Moyses Szklo  5 , David M Herrington  1 , Joseph Yeboah  6
Affiliations
Multicenter Study

Coronary artery calcium and incident cerebrovascular events in an asymptomatic cohort. The MESA Study

Ashleigh O Gibson et al. JACC Cardiovasc Imaging. 2014 Nov.

Abstract

Objectives: This study assessed the predictive value of coronary artery calcium (CAC) score for cerebrovascular events (CVE) in an asymptomatic multiethnic cohort.

Background: The CAC score, a measure of atherosclerotic burden, has been shown to improve prediction of coronary heart disease events. However, the predictive value of CAC for CVE is unclear.

Methods: CAC was measured at baseline examination of participants (N = 6,779) of MESA (Multi-Ethnic Study of Atherosclerosis) and then followed for an average of 9.5 ± 2.4 years for the diagnosis of incident CVE, defined as all strokes or transient ischemic attacks.

Results: During the follow-up, 234 (3.5%) adjudicated CVE occurred. In Kaplan-Meier analysis, the presence of CAC was associated with a lower CVE event-free survival versus the absence of CAC (log-rank chi-square: 59.8, p < 0.0001). Log-transformed CAC was associated with increased risk for CVE after adjusting for age, sex, race/ethnicity, body mass index, systolic and diastolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, cigarette smoking status, blood pressure medication use, statin use, and interim atrial fibrillation (hazard ratio [HR]: 1.13 [95% confidence interval (CI): 1.07 to 1.20], p < 0.0001). The American College of Cardiology/American Heart Association-recommended CAC cutoff was also an independent predictor of CVE and strokes (HR: 1.70 [95% CI: 1.24 to 2.35], p = 0.001, and HR: 1.59 [95% CI: 1.11 to 2.27], p = 0.01, respectively). CAC was an independent predictor of CVE when analysis was stratified by sex or race/ethnicity and improved discrimination for CVE when added to the full model (c-statistic: 0.744 vs. 0.755). CAC also improved the discriminative ability of the Framingham stroke risk score for CVE.

Conclusions: CAC is an independent predictor of CVE and improves the discrimination afforded by current stroke risk factors or the Framingham stroke risk score for incident CVE in an initially asymptomatic multiethnic adult cohort.

Keywords: cerebrovascular disease; coronary artery calcium score; prevention; risk prediction.

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Conflict of interest statement

Conflict of interest: None

Figures

Figure 1
Figure 1. Incident CVA in subjects with and without CAC
Kaplan Meier analysis showing the event- free survival of participants with and without coronary artery calcium and incident cerebrovascular events in the MESA cohort
Figure 2
Figure 2. Incident CVA by CAC Categories
Kaplan Meier analysis showing the CVA event-free survival of participants with < 0, 0–100, 100–400 and >400 coronary artery calcium(Agatston) and incident cerebrovascular events in the MESA cohort
Figure 3
Figure 3. CAC predicting CVA by global Risk
Plot of incident cerebrovascular (CVA) event rates within CAC categories [CAC=0 (1ST), CAC=0–100(2nd), CAC=101–400(3rd) and CAC>400 Agatston] across the median Framingham stroke risk score(FSRS) in MESA participants after 9.5 years of follow up.
Figure 4
Figure 4. Predictive Accuracy of CAC, FSRS and CAC + FSRS
Receiver Operating curves showing the discriminative ability of the full model, full model + coronary artery calcium (CAC), the Framingham stroke risk score(FSRS) and the FSRS + CAC for incident cerebrovascular events in the MESA cohort.
See this image and copyright information in PMC

Comment in

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