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Multicenter Study
. 2024 May:392:117521.
doi: 10.1016/j.atherosclerosis.2024.117521. Epub 2024 Mar 15.

Subclinical vascular composites predict clinical cardiovascular disease, stroke, and dementia: The Multi-Ethnic Study of Atherosclerosis (MESA)

Timothy M Hughes  1 , Jordan Tanley  2 , Haiying Chen  3 , Christopher L Schaich  4 , Joseph Yeboah  5 , Mark A Espeland  3 , Joao A C Lima  6 , Bharath Ambale-Venkatesh  6 , Erin D Michos  6 , Jingzhong Ding  2 , Kathleen Hayden  7 , Ramon Casanova  8 , Suzanne Craft  2 , Stephen R Rapp  9 , José A Luchsinger  10 , Annette L Fitzpatrick  11 , Susan R Heckbert  11 , Wendy S Post  6 , Gregory L Burke  12
Affiliations
Multicenter Study

Subclinical vascular composites predict clinical cardiovascular disease, stroke, and dementia: The Multi-Ethnic Study of Atherosclerosis (MESA)

Timothy M Hughes et al. Atherosclerosis. 2024 May.

Abstract

Background and aims: Subclinical cardiovascular disease (CVD) measures may reflect biological pathways that contribute to increased risk for coronary heart disease (CHD) events, stroke, and dementia beyond conventional risk scores.

Methods: The Multi-Ethnic Study of Atherosclerosis (MESA) followed 6814 participants (45-84 years of age) from baseline in 2000-2002 to 2018 over 6 clinical examinations and annual follow-up interviews. MESA baseline subclinical CVD procedures included: seated and supineblood pressure, coronary calcium scan, radial artery tonometry, and carotid ultrasound. Baseline subclinical CVD measures were transformed into z-scores before factor analysis to derive composite factor scores. Time to clinical event for all-cause CVD, CHD, stroke and ICD code-based dementia events were modeled using Cox proportional hazards models reported as area under the curve (AUC) with 95% Confidence Intervals (95%CI) at 10 and 15 years of follow-up. All models included all factor scores together, and adjustment for conventional risk scores for global CVD, stroke, and dementia.

Results: After factor selection, 24 subclinical measures aggregated into four distinct factors representing: blood pressure, atherosclerosis, arteriosclerosis, and cardiac factors. Each factor significantly predicted time to CVD events and dementia at 10 and 15 years independent of each other and conventional risk scores. Subclinical vascular composites of atherosclerosis and arteriosclerosis best predicted time to clinical events of CVD, CHD, stroke, and dementia. These results were consistent across sex and racial and ethnic groups.

Conclusions: Subclinical vascular composites of atherosclerosis and arteriosclerosis may be useful biomarkers to inform the vascular pathways contributing to events of CVD, CHD, stroke, and dementia.

Keywords: Aging; Cardiovascular risk; Cognition; Racial/ethnic differences; Subclinical cardiovascular disease.

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Conflict of interest statement

Declaration of competing interest statement The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Figure 1.
Figure 1.. Graphical abstract.
We applied factor analysis to extensive baseline subclinical cardiovascular disease (CVD) assessments to generate uncorrelated composites phenotypes representing atherosclerosis, arteriosclerosis, blood pressure, and cardiac function among individual free from clinical CVD at baseline of the Muti-Ethnic Study of Atherosclerosis (MESA). We then validated these factor composites against time to CVD events and ICD code defined dementia events over 18 years and showed that factors representing atherosclerosis and arteriosclerosis were most strongly associated with incident CVD events and dementia events.
Figure 2.
Figure 2.
ROC curves for subclinical composite factors and events of all cardiovascular disease (CVD), coronary heart disease (CHD), stroke, and ICD-defined dementia at 10 years.
Figure 3.
Figure 3.
Stratified proportional hazards models of subclinical vascular composites and CVD events. Models include all subclinical risk factor scores together.
See this image and copyright information in PMC

Update of

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