Thoracic aortic calcium, cardiovascular disease events, and all-cause mortality in asymptomatic individuals with zero coronary calcium

The Multi-Ethnic Study of Atherosclerosis (MESA)

Joonseok Kim, Matthew J. Budoff, Khurram Nasir, Nathan D. Wong, Joseph Yeboah, Mouaz H. Al-Mallah, Steve Shea, Zeina A. Dardari, Roger S Blumenthal, Michael Blaha, Miguel Cainzos-Achirica

Research output: Contribution to journalArticle

Abstract

Background and aims TAC is associated with incident CVD and all-cause mortality. Nevertheless, the independent 10-year prognostic value of TAC in individuals with CAC = 0 beyond traditional risk factors is not well established. Methods 3415 MESA participants with baseline CAC = 0 were followed for CHD, CVD events and all-cause mortality. TAC was measured in the ascending and descending aorta in all participants and quantified using Agatston's score. Multivariable Cox proportional hazards regression models were used to study the associations between TAC and incident CHD, CVD events and all-cause mortality. Likelihood ratio tests were used to compare prediction models including traditional risk factors plus TAC versus risk factors alone. Results 406 participants (11.9%) had TAC>0 at baseline. Over a median follow-up of 11.3 years, unadjusted event rates per 1000 person-years were higher in TAC>0 than in TAC = 0 participants: CHD 2.18 vs. 2.03; CVD 6.85 vs. 3.42; all-cause mortality 12.84 vs. 4.96. However, in multivariable Cox regression analyses adjusting for CVD risk factors, neither TAC>0, TAC>100 nor log(TAC+1) were independently associated with any of the study outcomes, nor improved their prediction compared to traditional risk factors alone (p value of likelihood ratio tests >0.05). Conclusions In a multi-ethnic, modern US population of asymptomatic individuals with CAC = 0 at baseline, the prevalence of TAC>0 was low, and TAC did not improve 10-year estimation of prognosis beyond traditional risk factors. In the presence of CAC = 0, measurement of TAC is unlikely to provide sufficient additional prognostic information to further improve risk assessment.

Original languageEnglish (US)
Pages (from-to)1-8
Number of pages8
JournalAtherosclerosis
Volume257
DOIs
StatePublished - Feb 1 2017

Fingerprint

Atherosclerosis
Cardiovascular Diseases
Thorax
Calcium
Mortality
Thoracic Aorta
Proportional Hazards Models
Aorta
Regression Analysis
Outcome Assessment (Health Care)
Population

Keywords

  • All-cause mortality
  • Cardiovascular disease
  • Coronary artery calcium
  • Thoracic aortic calcification

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Thoracic aortic calcium, cardiovascular disease events, and all-cause mortality in asymptomatic individuals with zero coronary calcium : The Multi-Ethnic Study of Atherosclerosis (MESA). / Kim, Joonseok; Budoff, Matthew J.; Nasir, Khurram; Wong, Nathan D.; Yeboah, Joseph; Al-Mallah, Mouaz H.; Shea, Steve; Dardari, Zeina A.; Blumenthal, Roger S; Blaha, Michael; Cainzos-Achirica, Miguel.

In: Atherosclerosis, Vol. 257, 01.02.2017, p. 1-8.

Research output: Contribution to journalArticle

Kim, Joonseok ; Budoff, Matthew J. ; Nasir, Khurram ; Wong, Nathan D. ; Yeboah, Joseph ; Al-Mallah, Mouaz H. ; Shea, Steve ; Dardari, Zeina A. ; Blumenthal, Roger S ; Blaha, Michael ; Cainzos-Achirica, Miguel. / Thoracic aortic calcium, cardiovascular disease events, and all-cause mortality in asymptomatic individuals with zero coronary calcium : The Multi-Ethnic Study of Atherosclerosis (MESA). In: Atherosclerosis. 2017 ; Vol. 257. pp. 1-8.
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abstract = "Background and aims TAC is associated with incident CVD and all-cause mortality. Nevertheless, the independent 10-year prognostic value of TAC in individuals with CAC = 0 beyond traditional risk factors is not well established. Methods 3415 MESA participants with baseline CAC = 0 were followed for CHD, CVD events and all-cause mortality. TAC was measured in the ascending and descending aorta in all participants and quantified using Agatston's score. Multivariable Cox proportional hazards regression models were used to study the associations between TAC and incident CHD, CVD events and all-cause mortality. Likelihood ratio tests were used to compare prediction models including traditional risk factors plus TAC versus risk factors alone. Results 406 participants (11.9{\%}) had TAC>0 at baseline. Over a median follow-up of 11.3 years, unadjusted event rates per 1000 person-years were higher in TAC>0 than in TAC = 0 participants: CHD 2.18 vs. 2.03; CVD 6.85 vs. 3.42; all-cause mortality 12.84 vs. 4.96. However, in multivariable Cox regression analyses adjusting for CVD risk factors, neither TAC>0, TAC>100 nor log(TAC+1) were independently associated with any of the study outcomes, nor improved their prediction compared to traditional risk factors alone (p value of likelihood ratio tests >0.05). Conclusions In a multi-ethnic, modern US population of asymptomatic individuals with CAC = 0 at baseline, the prevalence of TAC>0 was low, and TAC did not improve 10-year estimation of prognosis beyond traditional risk factors. In the presence of CAC = 0, measurement of TAC is unlikely to provide sufficient additional prognostic information to further improve risk assessment.",
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T1 - Thoracic aortic calcium, cardiovascular disease events, and all-cause mortality in asymptomatic individuals with zero coronary calcium

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

AU - Kim, Joonseok

AU - Budoff, Matthew J.

AU - Nasir, Khurram

AU - Wong, Nathan D.

AU - Yeboah, Joseph

AU - Al-Mallah, Mouaz H.

AU - Shea, Steve

AU - Dardari, Zeina A.

AU - Blumenthal, Roger S

AU - Blaha, Michael

AU - Cainzos-Achirica, Miguel

PY - 2017/2/1

Y1 - 2017/2/1

N2 - Background and aims TAC is associated with incident CVD and all-cause mortality. Nevertheless, the independent 10-year prognostic value of TAC in individuals with CAC = 0 beyond traditional risk factors is not well established. Methods 3415 MESA participants with baseline CAC = 0 were followed for CHD, CVD events and all-cause mortality. TAC was measured in the ascending and descending aorta in all participants and quantified using Agatston's score. Multivariable Cox proportional hazards regression models were used to study the associations between TAC and incident CHD, CVD events and all-cause mortality. Likelihood ratio tests were used to compare prediction models including traditional risk factors plus TAC versus risk factors alone. Results 406 participants (11.9%) had TAC>0 at baseline. Over a median follow-up of 11.3 years, unadjusted event rates per 1000 person-years were higher in TAC>0 than in TAC = 0 participants: CHD 2.18 vs. 2.03; CVD 6.85 vs. 3.42; all-cause mortality 12.84 vs. 4.96. However, in multivariable Cox regression analyses adjusting for CVD risk factors, neither TAC>0, TAC>100 nor log(TAC+1) were independently associated with any of the study outcomes, nor improved their prediction compared to traditional risk factors alone (p value of likelihood ratio tests >0.05). Conclusions In a multi-ethnic, modern US population of asymptomatic individuals with CAC = 0 at baseline, the prevalence of TAC>0 was low, and TAC did not improve 10-year estimation of prognosis beyond traditional risk factors. In the presence of CAC = 0, measurement of TAC is unlikely to provide sufficient additional prognostic information to further improve risk assessment.

AB - Background and aims TAC is associated with incident CVD and all-cause mortality. Nevertheless, the independent 10-year prognostic value of TAC in individuals with CAC = 0 beyond traditional risk factors is not well established. Methods 3415 MESA participants with baseline CAC = 0 were followed for CHD, CVD events and all-cause mortality. TAC was measured in the ascending and descending aorta in all participants and quantified using Agatston's score. Multivariable Cox proportional hazards regression models were used to study the associations between TAC and incident CHD, CVD events and all-cause mortality. Likelihood ratio tests were used to compare prediction models including traditional risk factors plus TAC versus risk factors alone. Results 406 participants (11.9%) had TAC>0 at baseline. Over a median follow-up of 11.3 years, unadjusted event rates per 1000 person-years were higher in TAC>0 than in TAC = 0 participants: CHD 2.18 vs. 2.03; CVD 6.85 vs. 3.42; all-cause mortality 12.84 vs. 4.96. However, in multivariable Cox regression analyses adjusting for CVD risk factors, neither TAC>0, TAC>100 nor log(TAC+1) were independently associated with any of the study outcomes, nor improved their prediction compared to traditional risk factors alone (p value of likelihood ratio tests >0.05). Conclusions In a multi-ethnic, modern US population of asymptomatic individuals with CAC = 0 at baseline, the prevalence of TAC>0 was low, and TAC did not improve 10-year estimation of prognosis beyond traditional risk factors. In the presence of CAC = 0, measurement of TAC is unlikely to provide sufficient additional prognostic information to further improve risk assessment.

KW - All-cause mortality

KW - Cardiovascular disease

KW - Coronary artery calcium

KW - Thoracic aortic calcification

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