Comparison of carotid plaque score and coronary artery calcium score for predicting cardiovascular disease events: The multi-ethnic study of atherosclerosis

Adam D. Gepner, Rebekah Young, Joseph A. Delaney, Matthew J. Budoff, Joseph F. Polak, Michael Blaha, Wendy S Post, Erin Donnelly Michos, Joel Kaufman, James H. Stein

Research output: Contribution to journalArticle

Abstract

Background-Coronary artery calcium (CAC) predicts coronary heart disease (CHD) events better than carotid wall plaque presence; however, differences in the utility of CAC burden and carotid plaque burden across the spectrum of cardiovascular disease (CVD) events is unknown. Methods and Results-CVD, CHD and stroke/transient ischemic attack (TIA) events were evaluated prospectively in a multiethnic cohort without CVD at baseline. Carotid plaque score was determined by the number of ultrasound-detected plaques in the common, bifurcation, and internal carotid artery segments. CAC was detected by computed tomography. Predictive values were compared using Cox proportional hazards models, C-statistics, and net reclassification, adjusting for traditional CVD risk factors. At baseline, the 4955 participants were mean (SD) 61.6 (10.1) years old and 52.8% female; 48.9% had CAC > 0 and 50.8% had at least 1 carotid plaque. After 11.3 (3.0) years of follow-up, 709 CVD, 498 CHD, and 262 stroke/TIA events occurred. CAC score compared to carotid plaque score was a stronger predictor of CVD (hazard ratio [HR], 1.78; 95% CI, 1.16-1.98; P < 0.001 vs HR, 1.27; 95% CI, 1.16-1.40; P < 0.001) and CHD events (HR, 2.09; 95% CI, 1.84-2.38; P < 0.001 vs HR, 1.35; 95% CI, 1.21-1.51; P < 0.001). CAC score and carotid plaque score were weak predictors of stroke/TIA. CAC score had better reclassification statistics than carotid plaque score, except for stroke/TIA, which had similar predictive values. Conclusions-CAC score improved prediction, discrimination, and reclassification of CVD and CHD better than carotid ultrasound measures, although prediction and discrimination were similar for stroke/TIA.

Original languageEnglish (US)
Article numbere005179
JournalJournal of the American Heart Association
Volume6
Issue number2
DOIs
StatePublished - 2017

Fingerprint

Atherosclerosis
Coronary Vessels
Cardiovascular Diseases
Transient Ischemic Attack
Calcium
Coronary Disease
Stroke
Common Carotid Artery
Internal Carotid Artery
Proportional Hazards Models
Tomography

Keywords

  • Atherosclerosis
  • Cardiovascular disease
  • Carotid artery
  • Imaging
  • Risk factor

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Comparison of carotid plaque score and coronary artery calcium score for predicting cardiovascular disease events : The multi-ethnic study of atherosclerosis. / Gepner, Adam D.; Young, Rebekah; Delaney, Joseph A.; Budoff, Matthew J.; Polak, Joseph F.; Blaha, Michael; Post, Wendy S; Michos, Erin Donnelly; Kaufman, Joel; Stein, James H.

In: Journal of the American Heart Association, Vol. 6, No. 2, e005179, 2017.

Research output: Contribution to journalArticle

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title = "Comparison of carotid plaque score and coronary artery calcium score for predicting cardiovascular disease events: The multi-ethnic study of atherosclerosis",
abstract = "Background-Coronary artery calcium (CAC) predicts coronary heart disease (CHD) events better than carotid wall plaque presence; however, differences in the utility of CAC burden and carotid plaque burden across the spectrum of cardiovascular disease (CVD) events is unknown. Methods and Results-CVD, CHD and stroke/transient ischemic attack (TIA) events were evaluated prospectively in a multiethnic cohort without CVD at baseline. Carotid plaque score was determined by the number of ultrasound-detected plaques in the common, bifurcation, and internal carotid artery segments. CAC was detected by computed tomography. Predictive values were compared using Cox proportional hazards models, C-statistics, and net reclassification, adjusting for traditional CVD risk factors. At baseline, the 4955 participants were mean (SD) 61.6 (10.1) years old and 52.8{\%} female; 48.9{\%} had CAC > 0 and 50.8{\%} had at least 1 carotid plaque. After 11.3 (3.0) years of follow-up, 709 CVD, 498 CHD, and 262 stroke/TIA events occurred. CAC score compared to carotid plaque score was a stronger predictor of CVD (hazard ratio [HR], 1.78; 95{\%} CI, 1.16-1.98; P < 0.001 vs HR, 1.27; 95{\%} CI, 1.16-1.40; P < 0.001) and CHD events (HR, 2.09; 95{\%} CI, 1.84-2.38; P < 0.001 vs HR, 1.35; 95{\%} CI, 1.21-1.51; P < 0.001). CAC score and carotid plaque score were weak predictors of stroke/TIA. CAC score had better reclassification statistics than carotid plaque score, except for stroke/TIA, which had similar predictive values. Conclusions-CAC score improved prediction, discrimination, and reclassification of CVD and CHD better than carotid ultrasound measures, although prediction and discrimination were similar for stroke/TIA.",
keywords = "Atherosclerosis, Cardiovascular disease, Carotid artery, Imaging, Risk factor",
author = "Gepner, {Adam D.} and Rebekah Young and Delaney, {Joseph A.} and Budoff, {Matthew J.} and Polak, {Joseph F.} and Michael Blaha and Post, {Wendy S} and Michos, {Erin Donnelly} and Joel Kaufman and Stein, {James H.}",
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T1 - Comparison of carotid plaque score and coronary artery calcium score for predicting cardiovascular disease events

T2 - The multi-ethnic study of atherosclerosis

AU - Gepner, Adam D.

AU - Young, Rebekah

AU - Delaney, Joseph A.

AU - Budoff, Matthew J.

AU - Polak, Joseph F.

AU - Blaha, Michael

AU - Post, Wendy S

AU - Michos, Erin Donnelly

AU - Kaufman, Joel

AU - Stein, James H.

PY - 2017

Y1 - 2017

N2 - Background-Coronary artery calcium (CAC) predicts coronary heart disease (CHD) events better than carotid wall plaque presence; however, differences in the utility of CAC burden and carotid plaque burden across the spectrum of cardiovascular disease (CVD) events is unknown. Methods and Results-CVD, CHD and stroke/transient ischemic attack (TIA) events were evaluated prospectively in a multiethnic cohort without CVD at baseline. Carotid plaque score was determined by the number of ultrasound-detected plaques in the common, bifurcation, and internal carotid artery segments. CAC was detected by computed tomography. Predictive values were compared using Cox proportional hazards models, C-statistics, and net reclassification, adjusting for traditional CVD risk factors. At baseline, the 4955 participants were mean (SD) 61.6 (10.1) years old and 52.8% female; 48.9% had CAC > 0 and 50.8% had at least 1 carotid plaque. After 11.3 (3.0) years of follow-up, 709 CVD, 498 CHD, and 262 stroke/TIA events occurred. CAC score compared to carotid plaque score was a stronger predictor of CVD (hazard ratio [HR], 1.78; 95% CI, 1.16-1.98; P < 0.001 vs HR, 1.27; 95% CI, 1.16-1.40; P < 0.001) and CHD events (HR, 2.09; 95% CI, 1.84-2.38; P < 0.001 vs HR, 1.35; 95% CI, 1.21-1.51; P < 0.001). CAC score and carotid plaque score were weak predictors of stroke/TIA. CAC score had better reclassification statistics than carotid plaque score, except for stroke/TIA, which had similar predictive values. Conclusions-CAC score improved prediction, discrimination, and reclassification of CVD and CHD better than carotid ultrasound measures, although prediction and discrimination were similar for stroke/TIA.

AB - Background-Coronary artery calcium (CAC) predicts coronary heart disease (CHD) events better than carotid wall plaque presence; however, differences in the utility of CAC burden and carotid plaque burden across the spectrum of cardiovascular disease (CVD) events is unknown. Methods and Results-CVD, CHD and stroke/transient ischemic attack (TIA) events were evaluated prospectively in a multiethnic cohort without CVD at baseline. Carotid plaque score was determined by the number of ultrasound-detected plaques in the common, bifurcation, and internal carotid artery segments. CAC was detected by computed tomography. Predictive values were compared using Cox proportional hazards models, C-statistics, and net reclassification, adjusting for traditional CVD risk factors. At baseline, the 4955 participants were mean (SD) 61.6 (10.1) years old and 52.8% female; 48.9% had CAC > 0 and 50.8% had at least 1 carotid plaque. After 11.3 (3.0) years of follow-up, 709 CVD, 498 CHD, and 262 stroke/TIA events occurred. CAC score compared to carotid plaque score was a stronger predictor of CVD (hazard ratio [HR], 1.78; 95% CI, 1.16-1.98; P < 0.001 vs HR, 1.27; 95% CI, 1.16-1.40; P < 0.001) and CHD events (HR, 2.09; 95% CI, 1.84-2.38; P < 0.001 vs HR, 1.35; 95% CI, 1.21-1.51; P < 0.001). CAC score and carotid plaque score were weak predictors of stroke/TIA. CAC score had better reclassification statistics than carotid plaque score, except for stroke/TIA, which had similar predictive values. Conclusions-CAC score improved prediction, discrimination, and reclassification of CVD and CHD better than carotid ultrasound measures, although prediction and discrimination were similar for stroke/TIA.

KW - Atherosclerosis

KW - Cardiovascular disease

KW - Carotid artery

KW - Imaging

KW - Risk factor

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