TY - JOUR
T1 - Coronary artery calcium and incident cerebrovascular events in an asymptomatic cohort the MESA study
AU - Gibson, Ashleigh O.
AU - Blaha, Michael J.
AU - Arnan, Martinson K.
AU - Sacco, Ralph L.
AU - Szklo, Moyses
AU - Herrington, David M.
AU - Yeboah, Joseph
N1 - Publisher Copyright:
© 2014 by the American College of Cardiology Foundation.
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.
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.
KW - Cerebrovascular disease
KW - Coronary artery calcium score
KW - Prevention
KW - Risk prediction
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U2 - 10.1016/j.jcmg.2014.07.009
DO - 10.1016/j.jcmg.2014.07.009
M3 - Article
C2 - 25459592
AN - SCOPUS:84922541611
SN - 1936-878X
VL - 7
SP - 1108
EP - 1115
JO - JACC: Cardiovascular Imaging
JF - JACC: Cardiovascular Imaging
IS - 11
ER -