Coronary artery calcium and incident cerebrovascular events in an asymptomatic cohort the MESA study

Ashleigh O. Gibson, Michael Blaha, Martinson K. Arnan, Ralph L. Sacco, Moyses Szklo, David M. Herrington, Joseph Yeboah

Research output: Contribution to journalArticle

Abstract

Objectives This study assessed the predictive value of coronary artery calcium (CAC) score for cerebrovascular events (CVE) in an asymptomatic multiethnic cohort. Background The CAC score, a measure of atherosclerotic burden, has been shown to improve prediction of coronary heart disease events. However, the predictive value of CAC for CVE is unclear. Methods CAC was measured at baseline examination of participants (N = 6,779) of MESA (Multi-Ethnic Study of Atherosclerosis) and then followed for an average of 9.5 ± 2.4 years for the diagnosis of incident CVE, defined as all strokes or transient ischemic attacks. Results During the follow-up, 234 (3.5%) adjudicated CVE occurred. In Kaplan-Meier analysis, the presence of CAC was associated with a lower CVE event-free survival versus the absence of CAC (log-rank chi-square: 59.8, p <0.0001). Log-transformed CAC was associated with increased risk for CVE after adjusting for age, sex, race/ethnicity, body mass index, systolic and diastolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, cigarette smoking status, blood pressure medication use, statin use, and interim atrial fibrillation (hazard ratio [HR]: 1.13 [95% confidence interval (CI): 1.07 to 1.20], p <0.0001). The American College of Cardiology/American Heart Association-recommended CAC cutoff was also an independent predictor of CVE and strokes (HR: 1.70 [95% CI: 1.24 to 2.35], p = 0.001, and HR: 1.59 [95% CI: 1.11 to 2.27], p = 0.01, respectively). CAC was an independent predictor of CVE when analysis was stratified by sex or race/ethnicity and improved discrimination for CVE when added to the full model (c-statistic: 0.744 vs. 0.755). CAC also improved the discriminative ability of the Framingham stroke risk score for CVE. Conclusions CAC is an independent predictor of CVE and improves the discrimination afforded by current stroke risk factors or the Framingham stroke risk score for incident CVE in an initially asymptomatic multiethnic adult cohort. (J Am Coll Cardiol Img 2014;7:1108-15)

Original languageEnglish (US)
Pages (from-to)1108-1115
Number of pages8
JournalJACC: Cardiovascular Imaging
Volume7
Issue number11
DOIs
StatePublished - 2014

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Atherosclerosis
Coronary Vessels
Calcium
Stroke
Confidence Intervals
Blood Pressure
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Aptitude
Transient Ischemic Attack
Kaplan-Meier Estimate
Atrial Fibrillation
HDL Cholesterol
Disease-Free Survival
Coronary Disease
Body Mass Index
Smoking
Cholesterol

Keywords

  • Cerebrovascular disease
  • Coronary artery calcium score
  • Prevention
  • Risk prediction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Coronary artery calcium and incident cerebrovascular events in an asymptomatic cohort the MESA study. / Gibson, Ashleigh O.; Blaha, Michael; Arnan, Martinson K.; Sacco, Ralph L.; Szklo, Moyses; Herrington, David M.; Yeboah, Joseph.

In: JACC: Cardiovascular Imaging, Vol. 7, No. 11, 2014, p. 1108-1115.

Research output: Contribution to journalArticle

Gibson, Ashleigh O. ; Blaha, Michael ; Arnan, Martinson K. ; Sacco, Ralph L. ; Szklo, Moyses ; Herrington, David M. ; Yeboah, Joseph. / Coronary artery calcium and incident cerebrovascular events in an asymptomatic cohort the MESA study. In: JACC: Cardiovascular Imaging. 2014 ; Vol. 7, No. 11. pp. 1108-1115.
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abstract = "Objectives This study assessed the predictive value of coronary artery calcium (CAC) score for cerebrovascular events (CVE) in an asymptomatic multiethnic cohort. Background The CAC score, a measure of atherosclerotic burden, has been shown to improve prediction of coronary heart disease events. However, the predictive value of CAC for CVE is unclear. Methods CAC was measured at baseline examination of participants (N = 6,779) of MESA (Multi-Ethnic Study of Atherosclerosis) and then followed for an average of 9.5 ± 2.4 years for the diagnosis of incident CVE, defined as all strokes or transient ischemic attacks. Results During the follow-up, 234 (3.5{\%}) adjudicated CVE occurred. In Kaplan-Meier analysis, the presence of CAC was associated with a lower CVE event-free survival versus the absence of CAC (log-rank chi-square: 59.8, p <0.0001). Log-transformed CAC was associated with increased risk for CVE after adjusting for age, sex, race/ethnicity, body mass index, systolic and diastolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, cigarette smoking status, blood pressure medication use, statin use, and interim atrial fibrillation (hazard ratio [HR]: 1.13 [95{\%} confidence interval (CI): 1.07 to 1.20], p <0.0001). The American College of Cardiology/American Heart Association-recommended CAC cutoff was also an independent predictor of CVE and strokes (HR: 1.70 [95{\%} CI: 1.24 to 2.35], p = 0.001, and HR: 1.59 [95{\%} CI: 1.11 to 2.27], p = 0.01, respectively). CAC was an independent predictor of CVE when analysis was stratified by sex or race/ethnicity and improved discrimination for CVE when added to the full model (c-statistic: 0.744 vs. 0.755). CAC also improved the discriminative ability of the Framingham stroke risk score for CVE. Conclusions CAC is an independent predictor of CVE and improves the discrimination afforded by current stroke risk factors or the Framingham stroke risk score for incident CVE in an initially asymptomatic multiethnic adult cohort. (J Am Coll Cardiol Img 2014;7:1108-15)",
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T1 - Coronary artery calcium and incident cerebrovascular events in an asymptomatic cohort the MESA study

AU - Gibson, Ashleigh O.

AU - Blaha, Michael

AU - Arnan, Martinson K.

AU - Sacco, Ralph L.

AU - Szklo, Moyses

AU - Herrington, David M.

AU - Yeboah, Joseph

PY - 2014

Y1 - 2014

N2 - Objectives This study assessed the predictive value of coronary artery calcium (CAC) score for cerebrovascular events (CVE) in an asymptomatic multiethnic cohort. Background The CAC score, a measure of atherosclerotic burden, has been shown to improve prediction of coronary heart disease events. However, the predictive value of CAC for CVE is unclear. Methods CAC was measured at baseline examination of participants (N = 6,779) of MESA (Multi-Ethnic Study of Atherosclerosis) and then followed for an average of 9.5 ± 2.4 years for the diagnosis of incident CVE, defined as all strokes or transient ischemic attacks. Results During the follow-up, 234 (3.5%) adjudicated CVE occurred. In Kaplan-Meier analysis, the presence of CAC was associated with a lower CVE event-free survival versus the absence of CAC (log-rank chi-square: 59.8, p <0.0001). Log-transformed CAC was associated with increased risk for CVE after adjusting for age, sex, race/ethnicity, body mass index, systolic and diastolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, cigarette smoking status, blood pressure medication use, statin use, and interim atrial fibrillation (hazard ratio [HR]: 1.13 [95% confidence interval (CI): 1.07 to 1.20], p <0.0001). The American College of Cardiology/American Heart Association-recommended CAC cutoff was also an independent predictor of CVE and strokes (HR: 1.70 [95% CI: 1.24 to 2.35], p = 0.001, and HR: 1.59 [95% CI: 1.11 to 2.27], p = 0.01, respectively). CAC was an independent predictor of CVE when analysis was stratified by sex or race/ethnicity and improved discrimination for CVE when added to the full model (c-statistic: 0.744 vs. 0.755). CAC also improved the discriminative ability of the Framingham stroke risk score for CVE. Conclusions CAC is an independent predictor of CVE and improves the discrimination afforded by current stroke risk factors or the Framingham stroke risk score for incident CVE in an initially asymptomatic multiethnic adult cohort. (J Am Coll Cardiol Img 2014;7:1108-15)

AB - Objectives This study assessed the predictive value of coronary artery calcium (CAC) score for cerebrovascular events (CVE) in an asymptomatic multiethnic cohort. Background The CAC score, a measure of atherosclerotic burden, has been shown to improve prediction of coronary heart disease events. However, the predictive value of CAC for CVE is unclear. Methods CAC was measured at baseline examination of participants (N = 6,779) of MESA (Multi-Ethnic Study of Atherosclerosis) and then followed for an average of 9.5 ± 2.4 years for the diagnosis of incident CVE, defined as all strokes or transient ischemic attacks. Results During the follow-up, 234 (3.5%) adjudicated CVE occurred. In Kaplan-Meier analysis, the presence of CAC was associated with a lower CVE event-free survival versus the absence of CAC (log-rank chi-square: 59.8, p <0.0001). Log-transformed CAC was associated with increased risk for CVE after adjusting for age, sex, race/ethnicity, body mass index, systolic and diastolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, cigarette smoking status, blood pressure medication use, statin use, and interim atrial fibrillation (hazard ratio [HR]: 1.13 [95% confidence interval (CI): 1.07 to 1.20], p <0.0001). The American College of Cardiology/American Heart Association-recommended CAC cutoff was also an independent predictor of CVE and strokes (HR: 1.70 [95% CI: 1.24 to 2.35], p = 0.001, and HR: 1.59 [95% CI: 1.11 to 2.27], p = 0.01, respectively). CAC was an independent predictor of CVE when analysis was stratified by sex or race/ethnicity and improved discrimination for CVE when added to the full model (c-statistic: 0.744 vs. 0.755). CAC also improved the discriminative ability of the Framingham stroke risk score for CVE. Conclusions CAC is an independent predictor of CVE and improves the discrimination afforded by current stroke risk factors or the Framingham stroke risk score for incident CVE in an initially asymptomatic multiethnic adult cohort. (J Am Coll Cardiol Img 2014;7:1108-15)

KW - Cerebrovascular disease

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