Association of Coronary Artery Calcium and Coronary Heart Disease Events in Young and Elderly Participants in the Multi-Ethnic Study of Atherosclerosis: A Secondary Analysis of a Prospective, Population-Based Cohort

doi:10.1016/j.mayocp.2014.05.017

Mayo Clinic Proceedings

Volume 89, Issue 10, October 2014, Pages 1350-1359

https://doi.org/10.1016/j.mayocp.2014.05.017 Get rights and content

Abstract

Objective

To evaluate the association of coronary artery calcium (CAC) and coronary heart disease (CHD) events among young and elderly individuals.

Participants and Methods

This is a secondary analysis of data from a prospective, multiethnic, population-based cohort study designed to study subclinical atherosclerosis. A total of 6809 persons 45 through 84 years old without known cardiovascular disease at baseline were enrolled from July 2000 through September 2002. All participants had CAC scoring performed and were followed up for a median of 8.5 years. The main outcome measures studied were CHD events, defined as myocardial infarction, definite angina or probable angina followed by revascularization, resuscitated cardiac arrest, or death attributable to CHD.

Results

Comparing individuals with a CAC score of 0 with those with a CAC score greater than 100, there was an increased incidence of CHD events from 1 to 21 per 1000 person-years and 2 to 23 per 1000 person-years in the 45- through 54-year-old and 75- through 84-year-old groups, respectively. Compared with a CAC score of 0, CAC scores of 1 through 100 and greater than 100 impart an increased multivariable-adjusted CHD event risk in the 45- through 54-year-old and 75- through 84-year-old groups (hazard ratio [HR], 2.3; 95% CI, 0.9-5.8; for those 45-54 years old with CAC scores of 1-100; HR, 12.4; 95% CI, 5.1-30.0; for those 45-54 years old with CAC scores >100: HR, 5.4; 95% CI, 1.2-23.8; for those 75-84 years old with CAC scores of 1-100; and HR, 12.1; 95% CI, 2.9-50.2; for those 75-84 years old with CAC scores >100).

Conclusion

Increased CAC imparts an increased CHD risk in younger and elderly individuals. CAC is highly predictive of CHD event risk across all age groups, suggesting that once CAC is known chronologic age has less importance. The utility of CAC scoring as a risk-stratification tool extends to both younger and elderly patients.

Section snippets

Methods

The Multi-Ethnic Study of Atherosclerosis (MESA) is a prospective, population-based cohort that comprises 4 prespecified ethnicities (white, African American, Hispanic, and Chinese) and 6 US communities (Baltimore City and Baltimore County, Maryland; Chicago, Illinois; Forsyth County, North Carolina; Los Angeles County, California; New York, New York; and St Paul, Minnesota). The primary goal of MESA is to evaluate the characteristics and risk factors of subclinical cardiovascular disease. The

Baseline Characteristics

Men constituted 47.1% of the population. As age increased, the percentage of patients with hypertension and diabetes mellitus increased and the proportion of current smokers decreased (Table 1). With increasing age, there was an increased proportion of patients with CAC scores of 1 through 100 and CAC scores greater than 100 (Figure 1). The percentage of patients with CAC scores greater than 100 increased from 3.3% at 45 years old to 53.8% at 82 years old. Conversely, the proportion of patients

Discussion

We found that increasing CAC score is significantly associated with a higher risk of all CHD events and hard CHD events in the 45- through 54-year-old and 75- through 84-year-old groups. The absence of CAC imparted a high CHD event-free survival regardless of age group. Although there was a higher risk of CHD events with increasing age, this risk was significantly attenuated after adjustment for CAC. At the extremes of age and CAC burden, younger adults with a high CAC score had a higher CHD

Conclusion

A CAC score of 0 in 75- through 84-year-old patients is associated with a lower risk of CHD events compared with higher CAC subgroups and compared with 45- through 54-year-old patients with high CAC scores. In the 45- through 54-year-old group, CAC has the potential to identify a subgroup of patients with advanced atherosclerosis who are at a much higher risk of death and CHD. This finding has immense potential in terms of refinement of current risk stratification methods so that aggressive

Acknowledgments

We thank the other investigators, staff, and participants of MESA for their valuable contributions. A full list of participating MESA investigators and institutions can be found at http://www.mesa-nhlbi.org.

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: For editorial comment, see page 1324

: Grant Support: This research was supported by grants N01-HC-95159 through N01-HC-95169 from the National Heart, Lung, and Blood Institute.

: Potential Competing Interests: Dr Matthew Budoff receives grant support from General Electric. All other authors report no relevant potential competing interests.

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Original articleAssociation of Coronary Artery Calcium and Coronary Heart Disease Events in Young and Elderly Participants in the Multi-Ethnic Study of Atherosclerosis: A Secondary Analysis of a Prospective, Population-Based Cohort

Abstract

Objective

Participants and Methods

Results

Conclusion

Section snippets

Methods

Baseline Characteristics

Discussion

Conclusion

Acknowledgments

Am Heart J

J Am Coll Cardiol

Int J Cardiol

J Am Coll Cardiol

Am J Cardiol

J Am Coll Cardiol

Am J Cardiol

J Am Coll Cardiol

JACC Cardiovasc Imaging

Lancet

J Am Coll Cardiol

ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography

Circulation

Original article
Association of Coronary Artery Calcium and Coronary Heart Disease Events in Young and Elderly Participants in the Multi-Ethnic Study of Atherosclerosis: A Secondary Analysis of a Prospective, Population-Based Cohort