Association between coronary artery calcification progression and microalbuminuria

The MESA study

Andrew P. Defilippis, Holly J. Kramer, Ronit Katz, Nathan D. Wong, Alain G. Bertoni, Jeffrey Carr, Matthew J. Budoff, Roger S Blumenthal, Khurram Nasir

Research output: Contribution to journalArticle

Abstract

Objectives: This study sought to evaluate the relationship between microalbuminuria (MA) and the development and progression of atherosclerosis, as assessed by incident and progression of coronary artery calcification (CAC). Background: MA is associated with an increased risk of cardiovascular disease, but the mechanism by which MA imparts this increased risk is not known. Methods: The MESA (Multi-Ethnic Study of Atherosclerosis) study is a prospective cohort study of 6,814 self-identified White, African-American, Hispanic, or Chinese participants free of clinical cardiovascular disease at entry. Of the 6,775 individuals with available urine albumin data, we excluded 97 subjects with macroalbuminuria and 1,023 with missing follow-up CAC data. The final study population consists of 5,666 subjects. Results: At baseline, individuals with MA were more likely to have CAC >0 compared with those without MA (62% vs. 48%, p <0.0001). During a mean follow-up of 2.4 ± 0.8 years, those with MA and no CAC at baseline were more likely to develop CAC (relative risk [RR]: 2.05, 95% confidence interval [CI]: 1.41 to 3.02, p <0.0001) as compared with those without MA in demographic-adjusted analyses. After multivariant adjustment, the relationship was attenuated but remained statistically significant (RR: 1.76, 95% CI: 1.19 to 2.61, p = 0.005). Among those with CAC at baseline, those with versus those without MA had a 15 (95% CI: 8 to 22, p <0.0001) volume units higher median increase in CAC in demographic-adjusted analyses. After multivariant adjustment, MA remained associated with incident CAC (RR: 1.76, 95% CI: 1.19 to 2.61, p = 0.005) and with progression of CAC (median increase in CAC volume score of 9 [95% CI: 2 to 16, p = 0.009]), relative to those without MA. Conclusions: This large multiethnic, population-based study of asymptomatic individuals demonstrates an increased risk of incident CAC as well as greater CAC progression among those with MA. Further study is needed to determine the degree to which MA precedes and predicts progression of atherosclerosis and how this information can be used to reduce cardiovascular events.

Original languageEnglish (US)
Pages (from-to)595-604
Number of pages10
JournalJACC: Cardiovascular Imaging
Volume3
Issue number6
DOIs
StatePublished - 2010

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Atherosclerosis
Coronary Vessels
Confidence Intervals
Cardiovascular Diseases
Demography
Hispanic Americans
African Americans
Population
Albumins
Cohort Studies
Urine
Prospective Studies

Keywords

  • coronary artery calcium
  • coronary heart disease
  • microalbuminuria
  • Multi-Ethnic Study of Atherosclerosis
  • risk prediction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

Cite this

Defilippis, A. P., Kramer, H. J., Katz, R., Wong, N. D., Bertoni, A. G., Carr, J., ... Nasir, K. (2010). Association between coronary artery calcification progression and microalbuminuria: The MESA study. JACC: Cardiovascular Imaging, 3(6), 595-604. https://doi.org/10.1016/j.jcmg.2010.01.008

Association between coronary artery calcification progression and microalbuminuria : The MESA study. / Defilippis, Andrew P.; Kramer, Holly J.; Katz, Ronit; Wong, Nathan D.; Bertoni, Alain G.; Carr, Jeffrey; Budoff, Matthew J.; Blumenthal, Roger S; Nasir, Khurram.

In: JACC: Cardiovascular Imaging, Vol. 3, No. 6, 2010, p. 595-604.

Research output: Contribution to journalArticle

Defilippis, AP, Kramer, HJ, Katz, R, Wong, ND, Bertoni, AG, Carr, J, Budoff, MJ, Blumenthal, RS & Nasir, K 2010, 'Association between coronary artery calcification progression and microalbuminuria: The MESA study', JACC: Cardiovascular Imaging, vol. 3, no. 6, pp. 595-604. https://doi.org/10.1016/j.jcmg.2010.01.008
Defilippis, Andrew P. ; Kramer, Holly J. ; Katz, Ronit ; Wong, Nathan D. ; Bertoni, Alain G. ; Carr, Jeffrey ; Budoff, Matthew J. ; Blumenthal, Roger S ; Nasir, Khurram. / Association between coronary artery calcification progression and microalbuminuria : The MESA study. In: JACC: Cardiovascular Imaging. 2010 ; Vol. 3, No. 6. pp. 595-604.
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abstract = "Objectives: This study sought to evaluate the relationship between microalbuminuria (MA) and the development and progression of atherosclerosis, as assessed by incident and progression of coronary artery calcification (CAC). Background: MA is associated with an increased risk of cardiovascular disease, but the mechanism by which MA imparts this increased risk is not known. Methods: The MESA (Multi-Ethnic Study of Atherosclerosis) study is a prospective cohort study of 6,814 self-identified White, African-American, Hispanic, or Chinese participants free of clinical cardiovascular disease at entry. Of the 6,775 individuals with available urine albumin data, we excluded 97 subjects with macroalbuminuria and 1,023 with missing follow-up CAC data. The final study population consists of 5,666 subjects. Results: At baseline, individuals with MA were more likely to have CAC >0 compared with those without MA (62{\%} vs. 48{\%}, p <0.0001). During a mean follow-up of 2.4 ± 0.8 years, those with MA and no CAC at baseline were more likely to develop CAC (relative risk [RR]: 2.05, 95{\%} confidence interval [CI]: 1.41 to 3.02, p <0.0001) as compared with those without MA in demographic-adjusted analyses. After multivariant adjustment, the relationship was attenuated but remained statistically significant (RR: 1.76, 95{\%} CI: 1.19 to 2.61, p = 0.005). Among those with CAC at baseline, those with versus those without MA had a 15 (95{\%} CI: 8 to 22, p <0.0001) volume units higher median increase in CAC in demographic-adjusted analyses. After multivariant adjustment, MA remained associated with incident CAC (RR: 1.76, 95{\%} CI: 1.19 to 2.61, p = 0.005) and with progression of CAC (median increase in CAC volume score of 9 [95{\%} CI: 2 to 16, p = 0.009]), relative to those without MA. Conclusions: This large multiethnic, population-based study of asymptomatic individuals demonstrates an increased risk of incident CAC as well as greater CAC progression among those with MA. Further study is needed to determine the degree to which MA precedes and predicts progression of atherosclerosis and how this information can be used to reduce cardiovascular events.",
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T1 - Association between coronary artery calcification progression and microalbuminuria

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AU - Defilippis, Andrew P.

AU - Kramer, Holly J.

AU - Katz, Ronit

AU - Wong, Nathan D.

AU - Bertoni, Alain G.

AU - Carr, Jeffrey

AU - Budoff, Matthew J.

AU - Blumenthal, Roger S

AU - Nasir, Khurram

PY - 2010

Y1 - 2010

N2 - Objectives: This study sought to evaluate the relationship between microalbuminuria (MA) and the development and progression of atherosclerosis, as assessed by incident and progression of coronary artery calcification (CAC). Background: MA is associated with an increased risk of cardiovascular disease, but the mechanism by which MA imparts this increased risk is not known. Methods: The MESA (Multi-Ethnic Study of Atherosclerosis) study is a prospective cohort study of 6,814 self-identified White, African-American, Hispanic, or Chinese participants free of clinical cardiovascular disease at entry. Of the 6,775 individuals with available urine albumin data, we excluded 97 subjects with macroalbuminuria and 1,023 with missing follow-up CAC data. The final study population consists of 5,666 subjects. Results: At baseline, individuals with MA were more likely to have CAC >0 compared with those without MA (62% vs. 48%, p <0.0001). During a mean follow-up of 2.4 ± 0.8 years, those with MA and no CAC at baseline were more likely to develop CAC (relative risk [RR]: 2.05, 95% confidence interval [CI]: 1.41 to 3.02, p <0.0001) as compared with those without MA in demographic-adjusted analyses. After multivariant adjustment, the relationship was attenuated but remained statistically significant (RR: 1.76, 95% CI: 1.19 to 2.61, p = 0.005). Among those with CAC at baseline, those with versus those without MA had a 15 (95% CI: 8 to 22, p <0.0001) volume units higher median increase in CAC in demographic-adjusted analyses. After multivariant adjustment, MA remained associated with incident CAC (RR: 1.76, 95% CI: 1.19 to 2.61, p = 0.005) and with progression of CAC (median increase in CAC volume score of 9 [95% CI: 2 to 16, p = 0.009]), relative to those without MA. Conclusions: This large multiethnic, population-based study of asymptomatic individuals demonstrates an increased risk of incident CAC as well as greater CAC progression among those with MA. Further study is needed to determine the degree to which MA precedes and predicts progression of atherosclerosis and how this information can be used to reduce cardiovascular events.

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KW - coronary heart disease

KW - microalbuminuria

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