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Coronary artery disease
Original research article
Association of cardiovascular disease risk factors with coronary artery calcium volume versus density
  1. Isac C Thomas1,2,
  2. Brandon Shiau1,
  3. Julie O Denenberg1,
  4. Robyn L McClelland3,
  5. Philip Greenland4,
  6. Ian H de Boer5,6,
  7. Bryan R Kestenbaum5,6,
  8. Gen-Min Lin7,
  9. Michael Daniels1,
  10. Nketi I Forbang1,
  11. Dena E Rifkin1,
  12. Jan Hughes-Austin1,
  13. Matthew A Allison1,
  14. J Jeffrey Carr8,
  15. Joachim H Ix1,
  16. Michael H Criqui1
  1. 1 Division of Preventive Medicine, Department of Family Medicine and Public Health, University of California, San Diego, California, USA
  2. 2 Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, California, USA
  3. 3 Department of Biostatistics, University of Washington, Seattle, Washington, USA
  4. 4 Department of Preventive Medicine, Northwestern University, Chicago, Illinois, USA
  5. 5 Department of Medicine, University of Washington, Seattle, Washington, USA
  6. 6 Department of Epidemiology, University of Washington, Seattle, Washington, USA
  7. 7 Department of Medicine, Hualien-Armed Forces General Hospital, Hualien County, Taiwan, China
  8. 8 Department of Radiology, Vanderbilt University, Nashville, Tennessee, USA
  1. Correspondence to Dr Isac C Thomas, Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, 9444 Medical Center Drive, La Jolla, CA 92037, USA; iicthomas{at}ucsd.edu

Abstract

Objectives Recently, the density score of coronary artery calcium (CAC) has been shown to be associated with a lower risk of cardiovascular disease (CVD) events at any level of CAC volume. Whether risk factors for CAC volume and CAC density are similar or distinct is unknown. We sought to evaluate the associations of CVD risk factors with CAC volume and CAC density scores.

Methods Baseline measurements from 6814 participants free of clinical CVD were collected for the Multi-Ethnic Study of Atherosclerosis. Participants with detectable CAC (n=3398) were evaluated for this study. Multivariable linear regression models were used to evaluate independent associations of CVD risk factors with CAC volume and CAC density scores.

Results Whereas most CVD risk factors were associated with higher CAC volume scores, many risk factors were associated with lower CAC density scores. For example, diabetes was associated with a higher natural logarithm (ln) transformed CAC volume score (standardised β=0.44 (95% CI 0.31 to 0.58) ln-units) but a lower CAC density score (β=−0.07 (−0.12 to −0.02) density units). Chinese, African-American and Hispanic race/ethnicity were each associated with lower ln CAC volume scores (β=−0.62 (−0.83to −0.41), −0.52 (−0.64 to −0.39) and −0.40 (−0.55 to −0.26) ln-units, respectively) and higher CAC density scores (β= 0.41 (0.34 to 0.47), 0.18 (0.12 to 0.23) and 0.21 (0.15 to 0.26) density units, respectively) relative to non-Hispanic White.

Conclusions In a cohort free of clinical CVD, CVD risk factors are differentially associated with CAC volume and density scores, with many CVD risk factors inversely associated with the CAC density score after controlling for the CAC volume score. These findings suggest complex associations between CVD risk factors and these components of CAC.

  • Coronary Artery Disease
  • Cardiac Risk Factors And Prevention
  • Cardiac Computer Tomographic (ct) Imaging

https://doi.org/10.1136/heartjnl-2017-311536

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    Footnotes

    • ICT and BS contributed equally,

    • JHI and MHC contributed equally.

    • Contributors ICT, BS, JHI and MHC contributed to study design. ICT, BS, JHI, MHC and JOD contributed to data analysis. ICT, BS, JHI and MHC contributed to manuscript preparation. ICT, BS and JOD contributed to figure creation. JOD, RLM, PG, IHdB, BRK, G-ML, MD, NIF, DER, JH-A, MAA, JJC, JHI and MC contributed to critical manuscript revision. ICT and MHC contributed to content guarantor.

    • Funding The MESA was supported by contracts N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168 and N01-HC-95169 from the National Heart, Lung and Blood Institute. This project was partially supported by the National Institutes of Health (NIH), Grant 5T35HL007491.

    • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

    • Competing interests None declared.

    • Ethics approval Institutional Review Board of centres involved.

    • Provenance and peer review Not commissioned; externally peer reviewed.