Coronary artery calcium and risk of dementia in MESA (Multi-Ethnic Study of Atherosclerosis)

Akira Fujiyoshi, David R. Jacobs, Annette L. Fitzpatrick, Alvaro Alonso, Daniel A. Duprez, A. Richey Sharrett, Teresa Seeman, Michael Blaha, José A. Luchsinger, Stephen R. Rapp

Research output: Contribution to journalArticle

Abstract

Background-Studies suggest a link between vascular injuries and dementia. Only a few studies, however, examined a longitudinal relation of subclinical vascular disease with dementia. We tested whether baseline coronary artery calcium (CAC), a biomarker of subclinical vascular disease, is associated with incident dementia independent of vascular risk factors and APOE-e4 genotype in a community-based sample. Methods and Results-We analyzed 6293 participants of MESA (Multi-Ethnic Study of Atherosclerosis), aged 45 to 84 years at baseline (2000-2002), initially free of cardiovascular disease and noticeable cognitive deficit. Dementia cases were identified using hospital and death certificate International Statistical Classification of Diseases and Related Health Problems codes. Cox models were used to obtain hazard ratios according to CAC category, or per 1 SD log2[CAC+1], adjusted for vascular risk factor, APOE-e4, with or without exclusion of interim stroke or cardiovascular disease. We observed 271 dementia cases in a median follow-up of 12.2 years. Baseline CAC had a graded positive association with dementia risk. Compared with no CAC, CAC score of 1 to 400, 401 to 1000, and =1001 had increased risk of dementia by 23%, 35%, and 71%, respectively, (Ptrend=0.026) after adjustment. 1 SD higher log2[CAC+1] was associated with 24% (95% confidence interval, 8%-41%; P=0.002) increase in dementia risk. Although the association was partially explained by interim stroke/cardiovascular disease, it remained significant even after excluding the interim events, or regardless of baseline age. Conclusions-Higher baseline CAC was significantly associated with increased risk of dementia independent of vascular risk factor, APOE-e4, and incident stroke. This is consistent with a hypothesis that vascular injuries play a role in the development of dementia.

Original languageEnglish (US)
Article numbere005349
JournalCirculation: Cardiovascular Imaging
Volume10
Issue number5
DOIs
StatePublished - May 1 2017

Fingerprint

Dementia
Atherosclerosis
Coronary Vessels
Calcium
Cardiovascular Diseases
Vascular System Injuries
Stroke
Vascular Diseases
Social Adjustment
Vascular Dementia
Death Certificates
International Classification of Diseases
Proportional Hazards Models
Biomarkers
Genotype
Confidence Intervals
vascular factor

Keywords

  • Atherosclerosis
  • Cohort
  • Coronary artery calcium
  • Dementia
  • Epidemiology
  • Stroke

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Fujiyoshi, A., Jacobs, D. R., Fitzpatrick, A. L., Alonso, A., Duprez, D. A., Sharrett, A. R., ... Rapp, S. R. (2017). Coronary artery calcium and risk of dementia in MESA (Multi-Ethnic Study of Atherosclerosis). Circulation: Cardiovascular Imaging, 10(5), [e005349]. https://doi.org/10.1161/CIRCIMAGING.116.005349

Coronary artery calcium and risk of dementia in MESA (Multi-Ethnic Study of Atherosclerosis). / Fujiyoshi, Akira; Jacobs, David R.; Fitzpatrick, Annette L.; Alonso, Alvaro; Duprez, Daniel A.; Sharrett, A. Richey; Seeman, Teresa; Blaha, Michael; Luchsinger, José A.; Rapp, Stephen R.

In: Circulation: Cardiovascular Imaging, Vol. 10, No. 5, e005349, 01.05.2017.

Research output: Contribution to journalArticle

Fujiyoshi, A, Jacobs, DR, Fitzpatrick, AL, Alonso, A, Duprez, DA, Sharrett, AR, Seeman, T, Blaha, M, Luchsinger, JA & Rapp, SR 2017, 'Coronary artery calcium and risk of dementia in MESA (Multi-Ethnic Study of Atherosclerosis)', Circulation: Cardiovascular Imaging, vol. 10, no. 5, e005349. https://doi.org/10.1161/CIRCIMAGING.116.005349
Fujiyoshi, Akira ; Jacobs, David R. ; Fitzpatrick, Annette L. ; Alonso, Alvaro ; Duprez, Daniel A. ; Sharrett, A. Richey ; Seeman, Teresa ; Blaha, Michael ; Luchsinger, José A. ; Rapp, Stephen R. / Coronary artery calcium and risk of dementia in MESA (Multi-Ethnic Study of Atherosclerosis). In: Circulation: Cardiovascular Imaging. 2017 ; Vol. 10, No. 5.
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abstract = "Background-Studies suggest a link between vascular injuries and dementia. Only a few studies, however, examined a longitudinal relation of subclinical vascular disease with dementia. We tested whether baseline coronary artery calcium (CAC), a biomarker of subclinical vascular disease, is associated with incident dementia independent of vascular risk factors and APOE-e4 genotype in a community-based sample. Methods and Results-We analyzed 6293 participants of MESA (Multi-Ethnic Study of Atherosclerosis), aged 45 to 84 years at baseline (2000-2002), initially free of cardiovascular disease and noticeable cognitive deficit. Dementia cases were identified using hospital and death certificate International Statistical Classification of Diseases and Related Health Problems codes. Cox models were used to obtain hazard ratios according to CAC category, or per 1 SD log2[CAC+1], adjusted for vascular risk factor, APOE-e4, with or without exclusion of interim stroke or cardiovascular disease. We observed 271 dementia cases in a median follow-up of 12.2 years. Baseline CAC had a graded positive association with dementia risk. Compared with no CAC, CAC score of 1 to 400, 401 to 1000, and =1001 had increased risk of dementia by 23{\%}, 35{\%}, and 71{\%}, respectively, (Ptrend=0.026) after adjustment. 1 SD higher log2[CAC+1] was associated with 24{\%} (95{\%} confidence interval, 8{\%}-41{\%}; P=0.002) increase in dementia risk. Although the association was partially explained by interim stroke/cardiovascular disease, it remained significant even after excluding the interim events, or regardless of baseline age. Conclusions-Higher baseline CAC was significantly associated with increased risk of dementia independent of vascular risk factor, APOE-e4, and incident stroke. This is consistent with a hypothesis that vascular injuries play a role in the development of dementia.",
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AU - Alonso, Alvaro

AU - Duprez, Daniel A.

AU - Sharrett, A. Richey

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AU - Blaha, Michael

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AB - Background-Studies suggest a link between vascular injuries and dementia. Only a few studies, however, examined a longitudinal relation of subclinical vascular disease with dementia. We tested whether baseline coronary artery calcium (CAC), a biomarker of subclinical vascular disease, is associated with incident dementia independent of vascular risk factors and APOE-e4 genotype in a community-based sample. Methods and Results-We analyzed 6293 participants of MESA (Multi-Ethnic Study of Atherosclerosis), aged 45 to 84 years at baseline (2000-2002), initially free of cardiovascular disease and noticeable cognitive deficit. Dementia cases were identified using hospital and death certificate International Statistical Classification of Diseases and Related Health Problems codes. Cox models were used to obtain hazard ratios according to CAC category, or per 1 SD log2[CAC+1], adjusted for vascular risk factor, APOE-e4, with or without exclusion of interim stroke or cardiovascular disease. We observed 271 dementia cases in a median follow-up of 12.2 years. Baseline CAC had a graded positive association with dementia risk. Compared with no CAC, CAC score of 1 to 400, 401 to 1000, and =1001 had increased risk of dementia by 23%, 35%, and 71%, respectively, (Ptrend=0.026) after adjustment. 1 SD higher log2[CAC+1] was associated with 24% (95% confidence interval, 8%-41%; P=0.002) increase in dementia risk. Although the association was partially explained by interim stroke/cardiovascular disease, it remained significant even after excluding the interim events, or regardless of baseline age. Conclusions-Higher baseline CAC was significantly associated with increased risk of dementia independent of vascular risk factor, APOE-e4, and incident stroke. This is consistent with a hypothesis that vascular injuries play a role in the development of dementia.

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