Cardiovascular events with absent or minimal coronary calcification

The Multi-Ethnic Study of Atherosclerosis (MESA)

Matthew J. Budoff, Robyn L. McClelland, Khurram Nasir, Philip Greenland, Richard A. Kronmal, George T. Kondos, Steven Shea, Joao Lima, Roger S Blumenthal

Research output: Contribution to journalArticle

Abstract

Background: Elevated coronary artery calcium (CAC) is a marker for increase risk of coronary heart disease (CHD). Although most CHD events occur among individuals with advanced CAC, CHD can also occur in individuals with little or no calcified plaque. In this study, we sought to evaluate the characteristics associated with incident CHD events in the setting of minimal (score ≤10) or absent CAC (score of zero). Methods: Asymptomatic participants in the MESA (N = 6,809) were followed for occurrence of all CHD events (including myocardial infarction, angina, resuscitated cardiac arrest, or CHD death) and hard CHD events (myocardial infarction or CHD death). Time to incident CHD was modeled using age-and gender-adjusted Cox regression. Results: The final study population consisted of 3,923 MESA asymptomatic participants (mean age 58 ± 9 years, 39% males) who had CAC scores of 0 to 10. Overall, no detectable CAC was seen in 3415 individuals, whereas 508 had CAC scores of 1 to 10. During follow-up (median 4.1 years), there were 16 incident hard events and 28 all CHD events in individuals with absent or minimal CAC. In age-, gender-, race-, and CHD risk factor-adjusted analysis, minimal CAC (1-10) was associated with an estimated 3-fold greater risk of a hard CHD event (HR 3.23, 95% CI 1.17-8.95) or of all CHD event (HR 3.66, 95% CI 1.71-7.85) compared to those with CAC = 0. Former smoking (HR 3.57, 95% CI 1.08-11.77), current smoking (HR 4.93, 95% CI 1.20-20.30), and diabetes (HR 3.09, 95% CI 1.07-8.93) were significant risk factors for events in those with CAC = 0. Conclusion: Asymptomatic persons with absent or minimal CAC are at very low risk of future cardiovascular events. Individuals with minimal CAC (1-10) were significantly increased to 3-fold increased risk for incident CHD events relative to those with CAC scores of zero.

Original languageEnglish (US)
Pages (from-to)554-561
Number of pages8
JournalAmerican Heart Journal
Volume158
Issue number4
DOIs
StatePublished - Oct 2009

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Coronary Disease
Atherosclerosis
Coronary Vessels
Calcium
Smoking
Myocardial Infarction
Heart Arrest
Statistical Factor Analysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Cardiovascular events with absent or minimal coronary calcification : The Multi-Ethnic Study of Atherosclerosis (MESA). / Budoff, Matthew J.; McClelland, Robyn L.; Nasir, Khurram; Greenland, Philip; Kronmal, Richard A.; Kondos, George T.; Shea, Steven; Lima, Joao; Blumenthal, Roger S.

In: American Heart Journal, Vol. 158, No. 4, 10.2009, p. 554-561.

Research output: Contribution to journalArticle

Budoff, Matthew J. ; McClelland, Robyn L. ; Nasir, Khurram ; Greenland, Philip ; Kronmal, Richard A. ; Kondos, George T. ; Shea, Steven ; Lima, Joao ; Blumenthal, Roger S. / Cardiovascular events with absent or minimal coronary calcification : The Multi-Ethnic Study of Atherosclerosis (MESA). In: American Heart Journal. 2009 ; Vol. 158, No. 4. pp. 554-561.
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title = "Cardiovascular events with absent or minimal coronary calcification: The Multi-Ethnic Study of Atherosclerosis (MESA)",
abstract = "Background: Elevated coronary artery calcium (CAC) is a marker for increase risk of coronary heart disease (CHD). Although most CHD events occur among individuals with advanced CAC, CHD can also occur in individuals with little or no calcified plaque. In this study, we sought to evaluate the characteristics associated with incident CHD events in the setting of minimal (score ≤10) or absent CAC (score of zero). Methods: Asymptomatic participants in the MESA (N = 6,809) were followed for occurrence of all CHD events (including myocardial infarction, angina, resuscitated cardiac arrest, or CHD death) and hard CHD events (myocardial infarction or CHD death). Time to incident CHD was modeled using age-and gender-adjusted Cox regression. Results: The final study population consisted of 3,923 MESA asymptomatic participants (mean age 58 ± 9 years, 39{\%} males) who had CAC scores of 0 to 10. Overall, no detectable CAC was seen in 3415 individuals, whereas 508 had CAC scores of 1 to 10. During follow-up (median 4.1 years), there were 16 incident hard events and 28 all CHD events in individuals with absent or minimal CAC. In age-, gender-, race-, and CHD risk factor-adjusted analysis, minimal CAC (1-10) was associated with an estimated 3-fold greater risk of a hard CHD event (HR 3.23, 95{\%} CI 1.17-8.95) or of all CHD event (HR 3.66, 95{\%} CI 1.71-7.85) compared to those with CAC = 0. Former smoking (HR 3.57, 95{\%} CI 1.08-11.77), current smoking (HR 4.93, 95{\%} CI 1.20-20.30), and diabetes (HR 3.09, 95{\%} CI 1.07-8.93) were significant risk factors for events in those with CAC = 0. Conclusion: Asymptomatic persons with absent or minimal CAC are at very low risk of future cardiovascular events. Individuals with minimal CAC (1-10) were significantly increased to 3-fold increased risk for incident CHD events relative to those with CAC scores of zero.",
author = "Budoff, {Matthew J.} and McClelland, {Robyn L.} and Khurram Nasir and Philip Greenland and Kronmal, {Richard A.} and Kondos, {George T.} and Steven Shea and Joao Lima and Blumenthal, {Roger S}",
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T1 - Cardiovascular events with absent or minimal coronary calcification

T2 - The Multi-Ethnic Study of Atherosclerosis (MESA)

AU - Budoff, Matthew J.

AU - McClelland, Robyn L.

AU - Nasir, Khurram

AU - Greenland, Philip

AU - Kronmal, Richard A.

AU - Kondos, George T.

AU - Shea, Steven

AU - Lima, Joao

AU - Blumenthal, Roger S

PY - 2009/10

Y1 - 2009/10

N2 - Background: Elevated coronary artery calcium (CAC) is a marker for increase risk of coronary heart disease (CHD). Although most CHD events occur among individuals with advanced CAC, CHD can also occur in individuals with little or no calcified plaque. In this study, we sought to evaluate the characteristics associated with incident CHD events in the setting of minimal (score ≤10) or absent CAC (score of zero). Methods: Asymptomatic participants in the MESA (N = 6,809) were followed for occurrence of all CHD events (including myocardial infarction, angina, resuscitated cardiac arrest, or CHD death) and hard CHD events (myocardial infarction or CHD death). Time to incident CHD was modeled using age-and gender-adjusted Cox regression. Results: The final study population consisted of 3,923 MESA asymptomatic participants (mean age 58 ± 9 years, 39% males) who had CAC scores of 0 to 10. Overall, no detectable CAC was seen in 3415 individuals, whereas 508 had CAC scores of 1 to 10. During follow-up (median 4.1 years), there were 16 incident hard events and 28 all CHD events in individuals with absent or minimal CAC. In age-, gender-, race-, and CHD risk factor-adjusted analysis, minimal CAC (1-10) was associated with an estimated 3-fold greater risk of a hard CHD event (HR 3.23, 95% CI 1.17-8.95) or of all CHD event (HR 3.66, 95% CI 1.71-7.85) compared to those with CAC = 0. Former smoking (HR 3.57, 95% CI 1.08-11.77), current smoking (HR 4.93, 95% CI 1.20-20.30), and diabetes (HR 3.09, 95% CI 1.07-8.93) were significant risk factors for events in those with CAC = 0. Conclusion: Asymptomatic persons with absent or minimal CAC are at very low risk of future cardiovascular events. Individuals with minimal CAC (1-10) were significantly increased to 3-fold increased risk for incident CHD events relative to those with CAC scores of zero.

AB - Background: Elevated coronary artery calcium (CAC) is a marker for increase risk of coronary heart disease (CHD). Although most CHD events occur among individuals with advanced CAC, CHD can also occur in individuals with little or no calcified plaque. In this study, we sought to evaluate the characteristics associated with incident CHD events in the setting of minimal (score ≤10) or absent CAC (score of zero). Methods: Asymptomatic participants in the MESA (N = 6,809) were followed for occurrence of all CHD events (including myocardial infarction, angina, resuscitated cardiac arrest, or CHD death) and hard CHD events (myocardial infarction or CHD death). Time to incident CHD was modeled using age-and gender-adjusted Cox regression. Results: The final study population consisted of 3,923 MESA asymptomatic participants (mean age 58 ± 9 years, 39% males) who had CAC scores of 0 to 10. Overall, no detectable CAC was seen in 3415 individuals, whereas 508 had CAC scores of 1 to 10. During follow-up (median 4.1 years), there were 16 incident hard events and 28 all CHD events in individuals with absent or minimal CAC. In age-, gender-, race-, and CHD risk factor-adjusted analysis, minimal CAC (1-10) was associated with an estimated 3-fold greater risk of a hard CHD event (HR 3.23, 95% CI 1.17-8.95) or of all CHD event (HR 3.66, 95% CI 1.71-7.85) compared to those with CAC = 0. Former smoking (HR 3.57, 95% CI 1.08-11.77), current smoking (HR 4.93, 95% CI 1.20-20.30), and diabetes (HR 3.09, 95% CI 1.07-8.93) were significant risk factors for events in those with CAC = 0. Conclusion: Asymptomatic persons with absent or minimal CAC are at very low risk of future cardiovascular events. Individuals with minimal CAC (1-10) were significantly increased to 3-fold increased risk for incident CHD events relative to those with CAC scores of zero.

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