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Wen H, Huang R, Xu X, Xiong Z, Liu M, Guo Y, Zhuang X, Liao X. Prognostic significance of aortic valve calcification in relation to coronary artery calcification for cardiovascular diseases. Eur J Prev Cardiol 2024; 31:1173-1182. [PMID: 38394450 DOI: 10.1093/eurjpc/zwae078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/25/2024] [Accepted: 01/30/2024] [Indexed: 02/25/2024]
Abstract
AIMS Both coronary artery calcification (CAC) and aortic valve calcification (AVC) are strongly associated with cardiovascular diseases (CVDs), but data about the prognostic significance of multiple cardiovascular calcifications are limited. We aim to investigate the interaction relationship between AVC and CAC for major events. METHODS AND RESULTS We included 6695 participants from the Multi-Ethnic Study of Atherosclerosis at baseline and divided them into four groups: (i) no AVC or CAC; (ii) only AVC; (iii) only CAC; and (iv) with CAC and CAC. The Cox regression model and the Kaplan-Meier method were used to analyse CVD outcomes. We evaluated the interaction between AVC and CAC and their added predictive value based on the pooled cohort equations (PCEs). Subgroup analyses were also explored. Among 6695 participants (mean age 62.2 ± 10.2 years, 47.2% male), after follow-up, 943 cases (14.1%) of CVD and 1274 cases (19.0%) of all-cause death occurred. For participants with both AVC and CAC, the risk of CVD significantly increased [hazard ratio = 3.43 (2.69-4.37), P < 0.001], even higher than the sum of the ones with only AVC and only CAC. This trend remained the same for all-cause death and among subgroup analyses. The addictive interaction was statistically significant (P < 0.001). When AVC and CAC were added, the predictive value of PCEs increased. CONCLUSION Our results indicated a synergistic interaction between valve calcification and coronary calcification in CVDs. Management for both AVC and CAC may bring health co-benefits in preventing poor outcomes.
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Affiliation(s)
- Han Wen
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
- NHC Key Laboratory of Assisted Circulation and Vascular Diseases, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
| | - Rihua Huang
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
- NHC Key Laboratory of Assisted Circulation and Vascular Diseases, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
| | - Xinghao Xu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
- NHC Key Laboratory of Assisted Circulation and Vascular Diseases, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
| | - Zhenyu Xiong
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
- NHC Key Laboratory of Assisted Circulation and Vascular Diseases, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
| | - Menghui Liu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
- NHC Key Laboratory of Assisted Circulation and Vascular Diseases, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
| | - Yue Guo
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
- NHC Key Laboratory of Assisted Circulation and Vascular Diseases, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
| | - Xiaodong Zhuang
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
- NHC Key Laboratory of Assisted Circulation and Vascular Diseases, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
| | - Xinxue Liao
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
- NHC Key Laboratory of Assisted Circulation and Vascular Diseases, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
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Xiao H, Wang X, Yang P, Wang L, Xu J. Coronary artery calcium scoring assessment in ultra-low-dose chest computed tomography. Clin Imaging 2024; 106:110045. [PMID: 38056107 DOI: 10.1016/j.clinimag.2023.110045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/21/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVES To investigate the effect of non-electrocardiogram (ECG) -triggered ultra-low-dose CT (ULD-CT) with different reconstruction protocols on coronary artery calcium (CAC) scoring assessment, compared with ECG-triggered CAC CT (CAC-CT). METHODS This prospective study included 115 patients who underwent CAC-CT and ULD-CT scans under the same topogram images. CAC-CT adopted a prospective ECG-triggered sequential acquisition with a tube potential of 120 kV, and the reconstruction protocol was standard Qr36 + slice 3 mm (CACQr-3mm group). ULD-CT adopted a non-ECG-triggered high-pitch acquisition with a tube potential of Sn100 kV, and four groups of images (named ULDQr-3mm, ULDSa-3mm, ULDQr-1.5mm, and ULDSa-1.5mm) were reconstructed using different reconstruction algorithms (standard Qr36, kV-independent Sa36) and slice thicknesses (3 mm, 1.5 mm). The accuracy of CAC detection by ULD-CT was calculated. The agreement of the CAC score between ULD-CT and CAC-CT scans was assessed using intraclass correlation coefficients (ICC) and Bland-Altman plot, and the agreement of risk categorization was assessed using weighted kappa. RESULTS The sensitivity and specificity of the ULDSa-1.5mm group for detecting positive CAC were 100% and 97.4%, respectively (k = 0.980). The CAC score for the ULDSa-3mm and ULDSa-1.5mm groups demonstrated excellent agreement with the CACQr-3mm group (ICC = 0.992, 0.990, respectively), with a mean difference of -12.3 and - 12.4. The agreement of risk categorization based on absolute and percentile CAC score between the ULDSa-1.5mm and CACQr-3mm groups was excellent (weighted k = 0.954, 0.983, respectively), and risk reclassification rates were low (3.5%, 2.8%, respectively). The effective dose was reduced by approximately 77.2% for the ULD-CT compared to the CAC-CT (0.18 mSv vs. 0.79 mSv, p < 0.001). CONCLUSION Reconstruction with a 1.5-mm slice thickness and kV-independent iterative algorithmic protocol in ULD-CT yielded excellent agreement in CAC score quantification and risk categorization compared with ECG-triggered CAC-CT.
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Affiliation(s)
- Huawei Xiao
- Heart Center, Department of Radiology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, China
| | - Xiangquan Wang
- Heart Center, Department of Radiology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, China
| | - Panfeng Yang
- Heart Center, Department of Radiology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, China
| | - Ling Wang
- Heart Center, Department of Radiology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, China
| | - Jian Xu
- Heart Center, Department of Radiology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, China.
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Garg PK, Bhatia HS, Allen TS, Grainger T, Pouncey AL, Dichek D, Virmani R, Golledge J, Allison MA, Powell JT. Assessment of Subclinical Atherosclerosis in Asymptomatic People In Vivo: Measurements Suitable for Biomarker and Mendelian Randomization Studies. Arterioscler Thromb Vasc Biol 2024; 44:24-47. [PMID: 38150519 PMCID: PMC10753091 DOI: 10.1161/atvbaha.123.320138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
BACKGROUND One strategy to reduce the burden of cardiovascular disease is the early detection and treatment of atherosclerosis. This has led to significant interest in studies of subclinical atherosclerosis, using different phenotypes, not all of which are accurate reflections of the presence of asymptomatic atherosclerotic plaques. The aim of part 2 of this series is to provide a review of the existing literature on purported measures of subclinical disease and recommendations concerning which tests may be appropriate in the prevention of incident cardiovascular disease. METHODS We conducted a critical review of measurements used to infer the presence of subclinical atherosclerosis in the major conduit arteries and focused on the predictive value of these tests for future cardiovascular events, independent of conventional cardiovascular risk factors, in asymptomatic people. The emphasis was on studies with >10 000 person-years of follow-up, with meta-analysis of results reporting adjusted hazard ratios (HRs) with 95% CIs. The arterial territories were limited to carotid, coronary, aorta, and lower limb arteries. RESULTS In the carotid arteries, the presence of plaque (8 studies) was independently associated with future stroke (pooled HR, 1.89 [1.04-3.44]) and cardiac events (7 studies), with a pooled HR, 1.77 (1.19-2.62). Increased coronary artery calcium (5 studies) was associated with the risk of coronary heart disease events, pooled HR, 1.54 (1.07-2.07) and increasing severity of calcification (by Agaston score) was associated with escalation of risk (13 studies). An ankle/brachial index (ABI) of <0.9, the pooled HR for cardiovascular death from 7 studies was 2.01 (1.43-2.81). There were insufficient studies of either, thoracic or aortic calcium, aortic diameter, or femoral plaque to synthesize the data based on consistent reporting of these measures. CONCLUSIONS The presence of carotid plaque, coronary artery calcium, or abnormal ankle pressures seems to be a valid indicator of the presence of subclinical atherosclerosis and may be considered for use in biomarker, Mendelian randomization and similar studies.
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Affiliation(s)
- Parveen K Garg
- Division of Cardiology, University of Southern California, Keck School of Medicine, Los Angeles (G.P.)
| | - Harpreet S Bhatia
- Division of Cardiovascular Medicine, University of California San Diego (B.H., A.T., A.M.A.)
| | - Tara S Allen
- Division of Cardiovascular Medicine, University of California San Diego (B.H., A.T., A.M.A.)
| | - Tabitha Grainger
- Department of Surgery & Cancer, Imperial College London (G.T., P.A.-L., P.J.T.)
| | - Anna L Pouncey
- Department of Surgery & Cancer, Imperial College London (G.T., P.A.-L., P.J.T.)
| | - David Dichek
- Division of Cardiology, Department of Medicine, University of Washington, Seattle (D.D.)
| | | | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, James Cook University and Townsville University Hospital, Australia (G.J.)
| | - Matthew A Allison
- Division of Cardiovascular Medicine, University of California San Diego (B.H., A.T., A.M.A.)
| | - Janet T Powell
- Department of Surgery & Cancer, Imperial College London (G.T., P.A.-L., P.J.T.)
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van Assen M, Tariq A, Razavi AC, Yang C, Banerjee I, De Cecco CN. Fusion Modeling: Combining Clinical and Imaging Data to Advance Cardiac Care. Circ Cardiovasc Imaging 2023; 16:e014533. [PMID: 38073535 PMCID: PMC10754220 DOI: 10.1161/circimaging.122.014533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
In addition to the traditional clinical risk factors, an increasing amount of imaging biomarkers have shown value for cardiovascular risk prediction. Clinical and imaging data are captured from a variety of data sources during multiple patient encounters and are often analyzed independently. Initial studies showed that fusion of both clinical and imaging features results in superior prognostic performance compared with traditional scores. There are different approaches to fusion modeling, combining multiple data resources to optimize predictions, each with its own advantages and disadvantages. However, manual extraction of clinical and imaging data is time and labor intensive and often not feasible in clinical practice. An automated approach for clinical and imaging data extraction is highly desirable. Convolutional neural networks and natural language processing can be utilized for the extraction of electronic medical record data, imaging studies, and free-text data. This review outlines the current status of cardiovascular risk prediction and fusion modeling; and in addition gives an overview of different artificial intelligence approaches to automatically extract data from images and electronic medical records for this purpose.
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Affiliation(s)
- Marly van Assen
- Translational Laboratory for Cardiothoracic Imaging and Artificial Intelligence, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
| | - Amara Tariq
- Machine Intelligence in Medicine and Imaging (MI-2) Lab, Mayo Clinic, AZ, USA
| | - Alexander C. Razavi
- Translational Laboratory for Cardiothoracic Imaging and Artificial Intelligence, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
- Emory Clinical Cardiovascular Research Institute, Emory University, Atlanta, GA, USA
| | - Carl Yang
- Computer Science, Emory University, Atlanta, GA, USA
| | - Imon Banerjee
- Machine Intelligence in Medicine and Imaging (MI-2) Lab, Mayo Clinic, AZ, USA
| | - Carlo N. De Cecco
- Translational Laboratory for Cardiothoracic Imaging and Artificial Intelligence, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
- Division of Cardiothoracic Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA USA
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Won KB, Choi SY, Chun EJ, Park SH, Sung J, Jung HO, Chang HJ. Assessment of Normal Systolic Blood Pressure Maintenance with the Risk of Coronary Artery Calcification Progression in Asymptomatic Metabolically Healthy Korean Adults with Normal Weight, Overweight, and Obesity. J Clin Med 2023; 12:jcm12113770. [PMID: 37297965 DOI: 10.3390/jcm12113770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/27/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
Metabolically healthy obesity (MHO) is known to have a close association with subclinical coronary atherosclerosis. Despite recent data on the benefit of intensive systolic blood pressure (SBP) control in diverse clinical conditions, little is known regarding the association of normal SBP maintenance (SBPmaintain) with coronary artery calcification (CAC) progression in MHO. This study included 2724 asymptomatic adults (48.8 ± 7.8 years; 77.9% men) who had no metabolic abnormalities except overweight and obesity. Participants with normal weight (44.2%), overweight (31.6%), and obesity (24.2%) were divided into two groups: normal SBPmaintain (follow-up SBP < 120 mm Hg) and ≥elevated SBPmaintain (follow-up SBP ≥ 120 mm Hg). CAC progression was defined using the SQRT method, a difference of ≥2.5 between the square root (√) of the baseline and follow-up coronary artery calcium score. During a mean follow-up of 3.4 years, the proportion of normal SBPmaintain (76.2%, 65.2%, and 59.1%) and the incidence of CAC progression (15.0%, 21.3%, and 23.5%) was different in participants with normal weight, overweight, and obesity (all p < 0.05, respectively). The incidence of CAC progression was lower in the normal SBPmaintain group than in the ≥elevated SBPmaintain group in only participants with obesity (20.8% vs. 27.4%, p = 0.048). In multiple logistic models, compared to participants with normal weight, those with obesity had a higher risk of CAC progression. Normal SBPmaintain was independently associated with the decreased risk of CAC progression in participants with obesity. MHO had a significant association with CAC progression. Normal SBPmaintain reduced the risk of CAC progression in asymptomatic adults with MHO.
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Affiliation(s)
- Ki-Bum Won
- Division of Cardiology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang 10326, Republic of Korea
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul 03722, Republic of Korea
| | - Su-Yeon Choi
- Division of Cardiology, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul 06236, Republic of Korea
| | - Eun Ju Chun
- Division of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea
| | - Sung Hak Park
- Division of Radiology, Gangnam Heartscan Clinic, Seoul 06168, Republic of Korea
| | - Jidong Sung
- Division of Cardiology, Heart Stroke & Vascular Institute, Samsung Medical Center, Seoul 06351, Republic of Korea
| | - Hae Ok Jung
- Division of Cardiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul 03722, Republic of Korea
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Razavi AC, Allen NB, Dzaye O, Michos ED, Budoff MJ, Lima JAC, Shikany JM, Liu K, Post WS, Blumenthal RS, Blaha MJ, Carr JJ, Whelton SP. Risk Factors for Incident Coronary Artery Calcium in Younger (Age 32 to 45 Years) Versus Intermediate (46 to 64 Years) Versus Older (65 to 84 Years) Persons. Am J Cardiol 2022; 184:14-21. [PMID: 36154968 DOI: 10.1016/j.amjcard.2022.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/08/2022] [Accepted: 08/11/2022] [Indexed: 11/01/2022]
Abstract
The prognostic value of traditional atherosclerotic cardiovascular disease (ASCVD) risk factors may decrease with age. We sought to determine whether the association between traditional ASCVD risk factors and incident coronary artery calcium (CAC) differs for younger versus older persons. We included 5,108 participants with baseline CAC = 0. Repeat CAC scoring occurred over 3 to 11 years of follow-up. Multivariable Cox proportional hazards regression assessed the association between traditional risk factors and incident CAC in young (32 to 45 years), middle-aged (46 to 64 years), and older adults (65 to 84 years). A total of 61% of the participants were women and 37% were Black. The proportion with incident CAC ranged from 22% among young adults, 34% for middle-aged adults, and 45% for older adults. In young adults, traditional risk factors were significantly associated with incident CAC except for diastolic blood pressure and high-density lipoprotein (HDL) cholesterol, whereas only total cholesterol/HDL cholesterol ≥3.5 (p = 0.04) was significantly associated with incident CAC in older persons. Non-HDL cholesterol (p = 0.02) was more strongly associated with incident CAC in young (hazard ratio [HR] 1.20, 95% confidence interval [CI] 1.09 to 1.31) and middle aged (HR 1.14, 95% CI 1.07 to 1.23) compared to older adults (HR 1.11, 95% CI 0.99 to 1.23). When added to demographics, traditional risk factors provided a greater C-statistic improvement for incident CAC prediction in young (0.752, +0.070, p <0.001) versus middle-aged (0.645, +0.054, p <0.001) and older adults (0.597,+0.025, p = 0.08). In conclusion, traditional risk factors more strongly predict incident CAC in young compared to older adults, underlining the importance of primordial prevention through middle age while identifying the challenges of ASCVD risk assessment in older persons.
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Affiliation(s)
- Alexander C Razavi
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Omar Dzaye
- Division of Cardiology, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Erin D Michos
- Division of Cardiology, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Matthew J Budoff
- Lundquist Institute, Harbor-UCLA Medical Center, Torrance, California
| | - Joao A C Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - James M Shikany
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Kiang Liu
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Wendy S Post
- Division of Cardiology, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Roger S Blumenthal
- Division of Cardiology, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael J Blaha
- Division of Cardiology, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - J Jeffrey Carr
- Department of Radiology and Radiological Sciences, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Seamus P Whelton
- Division of Cardiology, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Zheng Y, Joyce B, Hwang SJ, Ma J, Liu L, Allen N, Krefman A, Wang J, Gao T, Nannini D, Zhang H, Jacobs DR, Gross M, Fornage M, Lewis CE, Schreiner PJ, Sidney S, Chen D, Greenland P, Levy D, Hou L, Lloyd-Jones D. Association of Cardiovascular Health Through Young Adulthood With Genome-Wide DNA Methylation Patterns in Midlife: The CARDIA Study. Circulation 2022; 146:94-109. [PMID: 35652342 PMCID: PMC9348746 DOI: 10.1161/circulationaha.121.055484] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cardiovascular health (CVH) from young adulthood is strongly associated with an individual's future risk of cardiovascular disease (CVD) and total mortality. Defining epigenomic biomarkers of lifelong CVH exposure and understanding their roles in CVD development may help develop preventive and therapeutic strategies for CVD. METHODS In 1085 CARDIA study (Coronary Artery Risk Development in Young Adults) participants, we defined a clinical cumulative CVH score that combines body mass index, blood pressure, total cholesterol, and fasting glucose measured longitudinally from young adulthood through middle age over 20 years (mean age, 25-45). Blood DNA methylation at >840 000 methylation markers was measured twice over 5 years (mean age, 40 and 45). Epigenome-wide association analyses on the cumulative CVH score were performed in CARDIA and compared in the FHS (Framingham Heart Study). We used penalized regression to build a methylation-based risk score to evaluate the risk of incident coronary artery calcification and clinical CVD events. RESULTS We identified 45 methylation markers associated with cumulative CVH at false discovery rate <0.01 (P=4.7E-7-5.8E-17) in CARDIA and replicated in FHS. These associations were more pronounced with methylation measured at an older age. CPT1A, ABCG1, and SREBF1 appeared as the most prominent genes. The 45 methylation markers were mostly located in transcriptionally active chromatin and involved lipid metabolism, insulin secretion, and cytokine production pathways. Three methylation markers located in genes SARS1, SOCS3, and LINC-PINT statistically mediated 20.4% of the total effect between CVH and risk of incident coronary artery calcification. The methylation risk score added information and significantly (P=0.004) improved the discrimination capacity of coronary artery calcification status versus CVH score alone and showed association with risk of incident coronary artery calcification 5 to 10 years later independent of cumulative CVH score (odds ratio, 1.87; P=9.66E-09). The methylation risk score was also associated with incident clinical CVD in FHS (hazard ratio, 1.28; P=1.22E-05). CONCLUSIONS Cumulative CVH from young adulthood contributes to midlife epigenetic programming over time. Our findings demonstrate the role of epigenetic markers in response to CVH changes and highlight the potential of epigenomic markers for precision CVD prevention, and earlier detection of subclinical CVD, as well.
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Affiliation(s)
- Yinan Zheng
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Brian Joyce
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Shih-Jen Hwang
- Population Sciences Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Jiantao Ma
- Tufts University Friedman School of Nutrition Science and Policy, Boston, Massachusetts, USA
| | - Lei Liu
- Division of Biostatistics, Washington University, St. Louis, Missouri, USA
| | - Norrina Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Amy Krefman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jun Wang
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Tao Gao
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Drew Nannini
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Haixiang Zhang
- Center for Applied Mathematics, Tianjin University, Tianjin, China
| | - David R. Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Myron Gross
- Department of Laboratory Medicine and Pathology, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
| | - Myriam Fornage
- Institute of Molecular Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Cora E. Lewis
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Pamela J. Schreiner
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Stephen Sidney
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Dongquan Chen
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Philip Greenland
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Daniel Levy
- Population Sciences Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Lifang Hou
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Donald Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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8
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Bhatia HS, Lin F, Thomas IC, Denenberg J, Kandula NR, Budoff MJ, Criqui MH, Kanaya AM. Coronary artery calcium incidence and changes using direct plaque measurements: The MASALA study. Atherosclerosis 2022; 353:41-46. [PMID: 35618504 PMCID: PMC9793717 DOI: 10.1016/j.atherosclerosis.2022.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/02/2022] [Accepted: 05/10/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND AIMS We aimed to identify predictors of change in direct measures of coronary artery calcium (CAC) volume and density in South Asian participants. METHODS We used data from participants in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study with prevalent CAC and direct measures of CAC by serial computed tomography (CT) exams (2010-2013, 2016-2018). We examined the distribution of incident CAC volume and peak density, as well as progression and identified risk factors for progression of change in volume and density in multivariable models. RESULTS The study cohort consisted of 102 participants with incident CAC and 285 with CAC progression. CAC volume and density were highest, and incident CAC was most common in the left anterior descending artery (LAD). The greatest progression in volume was in the right coronary artery and the greatest change in density was in the left main. In linear regression models for CAC progression adjusted for baseline density, volume, risk factors, smoking (β +190.1, p = 0.02), baseline volume (β +0.24 per mm3, p < 0.01), and scan interval (β +0.15 per day, p = 0.01) were associated with change in total volume whereas Lp(a) (β +0.81 per mg/dL, p = 0.03), exercise (β +0.19 per 10 MET-min/week, p = 0.01), and baseline volume (β +0.15 per mm3, p < 0.01) and density (β -0.55 per unit, p < 0.01) were associated with change in total density. CONCLUSIONS In this South Asian cohort, smoking was associated with CAC volume progression, while Lp(a) and exercise were associated with progression of peak CAC density.
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Affiliation(s)
- Harpreet S. Bhatia
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, USA,Corresponding author. UCSD Cardiovascular Medicine, 9500 Gilman Drive, MC 7411, La Jolla, CA, USA. (H.S. Bhatia)
| | - Feng Lin
- Department of Epidemiology & Biostatistics, University of California, San Francisco, USA
| | - Isac C. Thomas
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, USA
| | - Julie Denenberg
- Division of Preventive Medicine, Department of Family Medicine, University of California, San Diego, USA
| | - Namratha R. Kandula
- Department of Medicine, Northwestern University Feinberg School of Medicine, USA
| | - Matthew J. Budoff
- Division of Cardiology, Lundquist Institute at Harbor-UCLA Medical Center, Los Angeles, USA
| | - Michael H. Criqui
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, USA,Division of Preventive Medicine, Department of Family Medicine, University of California, San Diego, USA
| | - Alka M. Kanaya
- Department of Epidemiology & Biostatistics, University of California, San Francisco, USA,Department of Medicine, University of California, San Francisco, USA
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9
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Jubran A, Mastrodicasa D, van Praagh GD, Willemink MJ, Kino A, Wang J, Fleischmann D, Nieman K. Low-dose coronary calcium scoring CT using a dedicated reconstruction filter for kV-independent calcium measurements. Eur Radiol 2022; 32:4225-4233. [PMID: 34989838 PMCID: PMC10017097 DOI: 10.1007/s00330-021-08451-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/27/2021] [Accepted: 10/30/2021] [Indexed: 11/29/2022]
Abstract
In this prospective, pilot study, we tested a kV-independent coronary artery calcium scoring CT protocol, using a novel reconstruction kernel (Sa36f). From December 2018 to November 2019, we performed an additional research scan in 61 patients undergoing clinical calcium scanning. For the standard protocol (120 kVp), images were reconstructed with a standard, medium-sharp kernel (Qr36d). For the research protocol (automated kVp selection), images were reconstructed with a novel kernel (Sa36f). Research scans were sequentially performed using a higher (cohort A, n = 31) and a lower (cohort B, n = 30) dose optimizer setting within the automatic system with customizable kV selection. Agatston scores, coronary calcium volumes, and radiation exposure of the standard and research protocol were compared. A phantom study was conducted to determine inter-scan variability. There was excellent correlation for the Agatston score between the two protocols (r = 0.99); however, the standard protocol resulted in slightly higher Agatston scores (29.4 [0-139.0] vs 17.4 [0-158.2], p = 0.028). The median calcium volumes were similar (11.5 [0-109.2] vs 11.2 [0-118.0] mm3; p = 0.176), and the number of calcified lesions was not significantly different (p = 0.092). One patient was reclassified to another risk category. The research protocol could be performed at a lower kV and resulted in a substantially lower radiation exposure, with a median volumetric CT dose index of 4.1 vs 5.2 mGy, respectively (p < 0.001). Our results showed that a consistent coronary calcium scoring can be achieved using a kV-independent protocol that lowers radiation doses compared to the standard protocol. KEY POINTS: • The Sa36f kernel enables kV-independent Agatston scoring without changing the original Agatston weighting threshold. • Agatston scores and calcium volumes of the standard and research protocols showed an excellent correlation. • The research protocol resulted in a significant reduction in radiation exposure with a mean reduction of 22% in DLP and 25% in CTDIvol.
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Affiliation(s)
- Ayman Jubran
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Domenico Mastrodicasa
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA.
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.
| | - Gijs D van Praagh
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands
| | - Martin J Willemink
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Aya Kino
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Jia Wang
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Dominik Fleischmann
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Koen Nieman
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
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10
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Mergen V, Higashigaito K, Allmendinger T, Manka R, Euler A, Alkadhi H, Eberhard M. Tube voltage-independent coronary calcium scoring on a first-generation dual-source photon-counting CT-a proof-of-principle phantom study. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:905-912. [PMID: 34780012 DOI: 10.1007/s10554-021-02466-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/02/2021] [Indexed: 10/19/2022]
Abstract
To evaluate the accuracy of coronary artery calcium (CAC) scoring at various tube voltages and different monoenergetic image reconstructions on a first-generation dual-source photon-counting detector CT (PCD-CT). A commercially available anthropomorphic chest phantom with calcium inserts was scanned at different tube voltages (90 kV, Sn100kV, 120 kV, and Sn140kV) on a first-generation dual-source PCD-CT system with quantum technology using automatic exposure control with an image quality (IQ) level of 20. The same phantom was also scanned on a conventional energy-integrating detector CT (120 kV; weighted filtered back projection) for reference. Extension rings were used to emulate different patient sizes. Virtual monoenergetic images at 65 keV and 70 keV applying different levels of quantum iterative reconstruction (QIR) were reconstructed from the PCD-CT data sets. CAC scores were determined and compared to the reference. Radiation doses were noted. At an IQ level of 20, radiation doses ranged between 1.18 mGy and 4.64 mGy, depending on the tube voltage and phantom size. Imaging at 90 kV or Sn100kV was associated with a size-dependent radiation dose reduction between 23% and 48% compared to 120 kV. Tube voltage adapted image reconstructions with 65 keV and QIR 3 at 90 kV and with 70 keV and QIR 1 at Sn100kV allowed to calculate CAC scores comparable to conventional EID-CT scans with a percentage deviation of ≤ 5% for all phantom sizes. Our phantom study indicates that CAC scoring with dual-source PCD-CT is accurate at various tube voltages, offering the possibility of substantial radiation dose reduction.
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Affiliation(s)
- V Mergen
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - K Higashigaito
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | | | - R Manka
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - A Euler
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - H Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - M Eberhard
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.
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11
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Hong JS, Tzeng YH, Yin WH, Wu KT, Hsu HY, Lu CF, Liu HR, Wu YT. Automated coronary artery calcium scoring using nested U-Net and focal loss. Comput Struct Biotechnol J 2022; 20:1681-1690. [PMID: 35465160 PMCID: PMC9010683 DOI: 10.1016/j.csbj.2022.03.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 03/24/2022] [Accepted: 03/24/2022] [Indexed: 11/28/2022] Open
Abstract
Coronary artery calcium (CAC) is a great risk predictor of the atherosclerotic cardiovascular disease and CAC scores can be used to stratify the risk of heart disease. Current clinical analysis of CAC is performed using onsite semiautomated software. This semiautomated CAC analysis requires experienced radiologists and radiologic technologists and is both demanding and time-consuming. The purpose of this study is to develop a fully automated CAC detection model that can quantify CAC scores. A total of 1,811 cases of cardiac examinations involving contrast-free multidetector computed tomography were retrospectively collected. We divided the database into the Training Data Set, Validation Data Set, Testing Data Set 1, and Testing Data Set 2. The Training, Validation, and Testing Data Set 1 contained cases with clinically detected CAC; Testing Data Set 2 contained those without detected calcium. The intraclass correlation coefficients between the overall standard and model-predicted scores were 1.00 for both the Training Data Set and Testing Data Set 1. In Testing Data Set 2, the model was able to detect clinically undetected cases of mild calcium. The results suggested that the proposed model’s automated detection of CAC was highly consistent with clinical semiautomated CAC analysis. The proposed model demonstrated potential for clinical applications that can improve the quality of CAC risk stratification.
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Affiliation(s)
- Jia-Sheng Hong
- Institute of Biophotonics, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Yun-Hsuan Tzeng
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Division of Advanced Medical Imaging, Health Management Center, Cheng Hsin General Hospital, Taipei 112, Taiwan
| | - Wei-Hsian Yin
- Division of Advanced Medical Imaging, Health Management Center, Cheng Hsin General Hospital, Taipei 112, Taiwan
- Heart Center, Cheng Hsin General Hospital, Taipei 112, Taiwan
| | - Kuan-Ting Wu
- Institute of Biophotonics, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Huan-Yu Hsu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Chia-Feng Lu
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Ho-Ren Liu
- Division of Advanced Medical Imaging, Health Management Center, Cheng Hsin General Hospital, Taipei 112, Taiwan
- Corresponding authors at: Institute of Biophotonics, National Yang Ming Chiao Tung University, No.155, Sec. 2, Linong St., Beitou Dist., Taipei City 112, Taiwan (Y.T. Wu). Health Management Center, Cheng Hsin General Hospital, No. 45, Zhenxing Street, Beitou District, Taipei City, 112, Taiwan (H.R. Liu).
| | - Yu-Te Wu
- Institute of Biophotonics, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Corresponding authors at: Institute of Biophotonics, National Yang Ming Chiao Tung University, No.155, Sec. 2, Linong St., Beitou Dist., Taipei City 112, Taiwan (Y.T. Wu). Health Management Center, Cheng Hsin General Hospital, No. 45, Zhenxing Street, Beitou District, Taipei City, 112, Taiwan (H.R. Liu).
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12
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Gao T, Wilkins JT, Zheng Y, Joyce BT, Jacobs DR, Schreiner PJ, Horvath S, Greenland P, Lloyd-Jones D, Hou L. Plasma lipid profiles in early adulthood are associated with epigenetic aging in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Clin Epigenetics 2022; 14:16. [PMID: 35101102 PMCID: PMC8805309 DOI: 10.1186/s13148-021-01222-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/19/2021] [Indexed: 11/21/2022] Open
Abstract
Background GrimAge acceleration (GAA), an epigenetic marker that represents physiologic aging, is associated with atherosclerotic cardiovascular disease. However, the associations between early adulthood lipid levels and GAA in midlife are unknown. Also, it is unknown whether GAA mediates the associations between lipid levels in young adults and subclinical atherosclerosis in midlife. Results We estimated measures of epigenetic age acceleration in 1118 White and Black participants from the Coronary Artery Risk Development in Young Adults (CARDIA) Study at examination years (Y) 15 and 20. We used multivariable regression models to examine associations of Y15 and Y20 GAA estimates with plasma lipid levels measured at prior examination years (Y0, Y5, and Y10) and concurrently: triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) levels. Mediation analysis was used to assess the extent to which GAA may mediate associations between plasma lipids and coronary artery calcification (CAC). In our study each 1-SD higher cumulative TG level was associated with an average 0.73 ± 0.12 years older GAA. Each 1-SD higher cumulative HDL-C level was associated with an average 0.57 ± 0.17 years younger GAA. Stratified analyses showed that the associations between TG and GAA were stronger among female and Black participants and the associations between HDL-C and GAA were stronger among female and White participants. GAA statistically mediated 17.4% of the association of cumulative TG with CAC. Conclusions High TG and low HDL-C in early adulthood are associated with accelerated epigenetic aging by midlife. Increased epigenetic age acceleration may partially mediate the associations between high TG levels and the presence of subclinical atherosclerosis. Supplementary Information The online version contains supplementary material available at 10.1186/s13148-021-01222-2.
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Affiliation(s)
- Tao Gao
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA.,Center for Global Oncology, Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - John T Wilkins
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA.,Department of Medicine (Cardiology), Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Yinan Zheng
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA.,Center for Global Oncology, Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Brian T Joyce
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA.,Center for Global Oncology, Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David R Jacobs
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Steve Horvath
- Department of Human Genetics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Philip Greenland
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA
| | - Donald Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA.,Department of Medicine (Cardiology), Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lifang Hou
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA. .,Center for Global Oncology, Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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13
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Sharma A, Ogunmoroti O, Fashanu OE, Zhao D, Ouyang P, Budoff MJ, Thomas IC, Michos ED. Associations of endogenous sex hormone levels with the prevalence and progression of valvular and thoracic aortic calcification in the Multi-Ethnic Study of Atherosclerosis (MESA). Atherosclerosis 2022; 341:71-79. [PMID: 34785061 PMCID: PMC8760158 DOI: 10.1016/j.atherosclerosis.2021.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 10/24/2021] [Accepted: 11/04/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND AIMS Sex hormones (SH) may contribute to sex differences in cardiovascular disease (CVD). High free testosterone (T) and low sex hormone binding globulin (SHBG) have been associated with progression of coronary artery calcification in women. We now examined the association of SH with extra-coronary calcification (ECC) prevalence and progression among MESA participants. METHODS We studied 2,737 postmenopausal women and 3,130 men free of clinical CVD with baseline SH levels. ECC measurements [ascending and descending thoracic aortic calcification (ATAC, DTAC), mitral annular calcification (MAC), aortic valve calcification (AVC)] were obtained by computed tomography at baseline and after 2.4 ± 0.9 years. We used multivariable Poisson regression to evaluate associations with ECC prevalence and incidence (Agatston scores >0) and linear mixed effects models for ECC progression, per 1-SD increment in log(SH) in women and men separately. RESULTS The mean age was 65 ± 9 and 62 ± 10 years for women and men, respectively. In women, greater free T and lower SHBG were associated with MAC incidence in a demographic-adjusted model only. In men, lower free T was associated with MAC prevalence, DTAC incidence and progression, while greater SHBG was associated with MAC prevalence and DTAC progression after further adjusting for CVD risk factors. CONCLUSIONS In this diverse cohort free of CVD, we found some associations of SH with ECC measures. In particular, free T was inversely associated with prevalent MAC and DTAC progression in men independent of CVD risk factors. SH may influence vascular calcification, but further work is needed to understand clinical implications of these findings.
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Affiliation(s)
- Apurva Sharma
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Oluseye Ogunmoroti
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Di Zhao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Pamela Ouyang
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Isac C. Thomas
- Division of Cardiology, University of California San Diego, San Diego, CA, USA
| | - Erin D. Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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14
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Jurgens PT, Carr JJ, Terry JG, Rana JS, Jacobs DR, Duprez DA. Association of Abdominal Aorta Calcium and Coronary Artery Calcium with Incident Cardiovascular and Coronary Heart Disease Events in Black and White Middle-Aged People: The Coronary Artery Risk Development in Young Adults Study. J Am Heart Assoc 2021; 10:e023037. [PMID: 34873926 PMCID: PMC9075251 DOI: 10.1161/jaha.121.023037] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 11/04/2021] [Indexed: 11/25/2022]
Abstract
Background Assessing coronary artery calcium (CAC) is among AHA/ACC prevention guidelines for people at least 40 years old at intermediate risk for coronary heart disease (CHD). To study enhanced risk stratification, we investigated the predictive value of abdominal aorta calcium (AAC) relative to CAC for cardiovascular disease (CVD) and CHD events in Black and White early middle-aged participants, initially free of overt CVD. Methods and Results In the CARDIA (Coronary Artery Risk Development in Young Adults) study, a multi-center, community-based, longitudinal cohort study of CVD risk, the CAC and AAC scores were assessed in 3011 participants in 2010-2011 with follow-up until 2019 for incident CVD and CHD events. Distributions and predictions, overall and by race, were computed. During the 8-year follow-up, 106 incident CVD events (55 were CHD) occurred. AAC scores tended to be much higher than CAC scores. AAC scores were higher in Black women than in White women. CAC predicted CVD with HR 1.77 (1.52-2.06) and similarly for AAC, while only CAC predicted CHD. After adjustment for risk factors and calcium in the other arterial bed, the association of CAC with CVD was independent of risk factors and AAC, while the association of AAC with CVD was greatly attenuated. However, AAC predicted incident CVD when CAC was 0. Prediction did not vary by race. Conclusions AAC predicted CVD nearly as strongly as CAC and could be especially useful as a diagnostic tool when it is an incidental finding or when no CAC is found.
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Affiliation(s)
- Paul T. Jurgens
- Division of CardiologyDepartment of MedicineUniversity of MinnesotaMinneapolisMN
| | - John J. Carr
- Division of Radiology and Radiological SciencesVanderbilt University Medical CenterNashvilleTN
| | - James G. Terry
- Division of Radiology and Radiological SciencesVanderbilt University Medical CenterNashvilleTN
| | - Jamal S. Rana
- Division of Cardiology and ResearchKaiser Permanente Northern CaliforniaOaklandCA
| | - David R. Jacobs
- Division of Epidemiology and Community HealthSchool of Public HealthUniversity of MinnesotaMinneapolisMN
| | - Daniel A. Duprez
- Division of CardiologyDepartment of MedicineUniversity of MinnesotaMinneapolisMN
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15
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Razavi AC, Cardoso R, Dzaye O, Budoff M, Thanassoulis G, Post WS, Shah S, Berman DS, Nasir K, Blaha MJ, Whelton SP. Risk Markers for Limited Coronary Artery Calcium in Persons With Significant Aortic Valve Calcium (From the Multi-ethnic Study of Atherosclerosis). Am J Cardiol 2021; 156:58-64. [PMID: 34325879 PMCID: PMC8429123 DOI: 10.1016/j.amjcard.2021.06.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/14/2021] [Accepted: 06/18/2021] [Indexed: 10/20/2022]
Abstract
The early stages of aortic valve calcification (AVC) and coronary artery calcification (CAC) include shared ASCVD risk factors, yet there is considerable heterogeneity between the burden of AVC, and CAC. We sought to identify the markers associated with limited CAC among persons with significant AVC. There were 325 participants from the Multi-Ethnic Study of Atherosclerosis without clinical ASCVD and with AVC ≥100 Agatston units (AU) at Visit 1. Multivariable-adjusted prevalence ratios for limited CAC (0 to 99 AU) were calculated using modified Poisson regression. Participants had a mean age of 72.1 years, median AVC score of 209, and 34% were women. A total of 133 (41%) participants had CAC <100, of whom 46/133 had CAC = 0. Younger age (PR = 1.40, 95% CI: 1.22 to 1.62, per 10-years), female gender (PR = 1.68, 95% CI: 1.28 to 2.20), and low 10-year ASCVD risk (PR = 2.30, 95% CI: 1.85 to 2.85) were most strongly associated with limited CAC. Neither a normal lipoprotein(a) nor normal measures of inflammation were significantly associated with limited CAC. Lower serum phosphate (PR = 1.15, 95% CI: 1.01 to 1.31; per 0.5 mg/dl lower) and calcium-phosphate product (PR = 1.16, 95% CI: 1.02 to 1.34; per SD lower) were associated with an approximately 15% higher prevalence of limited CAC. In conclusion, more than 40% of persons with significant AVC had CAC. Beyond traditional risk factors, lower serum phosphate, and lower calcium-phosphate product were associated with a higher prevalence of limited CAC.
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Affiliation(s)
- Alexander C Razavi
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Rhanderson Cardoso
- Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Baltimore, Maryland
| | - Omar Dzaye
- The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Matthew Budoff
- Los Angeles Biomedical Research Center, Torrance, California
| | - George Thanassoulis
- Preventive and Genomic Cardiology, McGill University Health Center, Montreal, Quebec, Canada
| | - Wendy S Post
- The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sanjiv Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Daniel S Berman
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Michael J Blaha
- The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Seamus P Whelton
- The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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16
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Won KB, Han D, Choi SY, Chun EJ, Park SH, Han HW, Sung J, Jung HO, Chang HJ. Association between blood pressure classification defined by the 2017 ACC/AHA guidelines and coronary artery calcification progression in an asymptomatic adult population. EUROPEAN HEART JOURNAL OPEN 2021; 1:oeab009. [PMID: 35919095 PMCID: PMC9242050 DOI: 10.1093/ehjopen/oeab009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/15/2021] [Indexed: 11/13/2022]
Abstract
Aims Coronary artery calcium score (CACS) is widely used for cardiovascular risk stratification in asymptomatic population. We assessed the association of new blood pressure (BP) classification using the 2017 American College of Cardiology/American Heart Association guidelines with coronary artery calcification (CAC) progression according to age in asymptomatic adults. Methods and results Overall, 10 839 asymptomatic Korean adults (23.4% aged ≤45 years) who underwent at least two CACS evaluations for health check-up were enrolled. Participants were categorized by age (≤45 and >45 years) and BP [normal (<120/<80 mmHg, untreated), elevated (120-129/<80 mmHg, untreated), Stage 1 hypertension (untreated BP 130-139/80-89 mmHg) or Stage 2 hypertension (BP ≥140/≥90 mmHg or anti-hypertensive use)] groups. CAC progression was defined as a difference of ≥2.5 between the square root (√) of the baseline and follow-up CACS. During a mean 3.3-year follow-up, the incidence of CAC progression was 13.5% and 36.3% in individuals aged ≤45 and >45 years, respectively. After adjustment for age, sex, diabetes, dyslipidaemia, obesity, current smoking, and baseline CACS, hazard ratios (95% confidence interval) for CAC progression in elevated BP, Stage 1 hypertension, and Stage 2 hypertension compared to normal BP were 1.43 (0.96-2.14) (P = 0.077), 1.64 (1.20-2.23) (P = 0.002), and 2.38 (1.82-3.12) (P < 0.001) in the ≤45 years group and 1.11 (0.95-1.30) (P = 0.179), 1.17 (1.04-1.32) (P = 0.009), and 1.52 (1.39-1.66) (P < 0.001) in the >45 years group, respectively. Conclusion Newly defined Stage 1 hypertension is independently associated with CAC progression in asymptomatic adults regardless of age.
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Affiliation(s)
- Ki-Bum Won
- Division of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - Donghee Han
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
- Department of Imaging and Medicine, Cedars-Sinai Medical Centre, Los Angeles, CA, USA
| | - Su-Yeon Choi
- Division of Cardiology, Healthcare System Gangnam Centre, Seoul National University Hospital, Seoul, South Korea
| | - Eun Ju Chun
- Division of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sung Hak Park
- Division of Radiology, Gangnam Heartscan Clinic, Seoul, South Korea
| | - Hae-Won Han
- Department of Internal Medicine, Gangnam Heartscan Clinic, Seoul, South Korea
| | - Jidong Sung
- Division of Cardiology, Heart Stroke & Vascular Institute, Samsung Medical Centre, Seoul, South Korea
| | - Hae Ok Jung
- Division of Cardiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
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Razavi AC, Kelly TN, Budoff MJ, Bazzano LA, He J, Fernandez C, Lima J, Nasir K, Blumenthal RS, Blaha MJ, Whelton SP. Atherosclerotic cardiovascular disease events among statin eligible individuals with and without long-term healthy arterial aging. Atherosclerosis 2021; 326:56-62. [PMID: 33824003 PMCID: PMC8215721 DOI: 10.1016/j.atherosclerosis.2021.03.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/13/2021] [Accepted: 03/18/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND AIMS A large proportion of statin eligible candidates have a baseline absence of coronary artery calcium (CAC) and low 10-year atherosclerotic cardiovascular disease (ASCVD) risk. We sought to determine the proportion of statin eligible individuals who had long-term healthy arterial aging (persistent CAC = 0) and their examined 15-year ASCVD outcomes. METHODS We included 561 statin eligible candidates from the Multi-Ethnic Study of Atherosclerosis who were not on statin therapy with CAC = 0 at Visit 1 (2000-02) and underwent a subsequent CAC scan at Visit 5 (2010-11). Adjusted Cox proportional hazards regression assessed the association between persistent CAC = 0 and ASCVD events over 15.9 years. RESULTS Participants were on average 61.7 years old, 50% were women, and 43% maintained long-term CAC = 0. Individuals with an LDL-C ≥190 mg/dL (54%) and those with an ASCVD risk ≥20% (33%) had the highest and lowest proportion of persistent CAC = 0, respectively. There were 57 ASCVD events, and 15-year ASCVD event rates were low for individuals with and without healthy arterial aging (4.3 versus 8.6 per 1,000 persons-years), but the 10-year number needed to treat to prevent one ASCVD event differed by more than two fold (117 versus 54). In multivariable modeling, persistent CAC = 0 conferred a 51% lower risk of ASCVD compared to those with incident CAC (HR = 0.49, 95% CI: 0.27-0.90, p=0.02). CONCLUSIONS More than 40% of statin eligible individuals with baseline CAC = 0 had long-term healthy arterial aging. Statin eligible candidates with persistent CAC = 0 had a very low 15-year ASCVD risk, suggesting that statin therapy may be of limited benefit among this group of individuals.
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Affiliation(s)
- Alexander C Razavi
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA, United States; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States
| | - Tanika N Kelly
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA, United States
| | - Matthew J Budoff
- Los Angeles Biomedical Research Center, Torrance, CA, United States
| | - Lydia A Bazzano
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA, United States; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States
| | - Jiang He
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA, United States; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States
| | - Camilo Fernandez
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA, United States; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States
| | - Joao Lima
- Johns Hopkins University School of Medicine, Division of Cardiology, Baltimore, MD, United States
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, United States
| | - Roger S Blumenthal
- The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Michael J Blaha
- The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Seamus P Whelton
- The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
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18
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Orringer CE, Blaha MJ, Blankstein R, Budoff MJ, Goldberg RB, Gill EA, Maki KC, Mehta L, Jacobson TA. The National Lipid Association scientific statement on coronary artery calcium scoring to guide preventive strategies for ASCVD risk reduction. J Clin Lipidol 2021; 15:33-60. [PMID: 33419719 DOI: 10.1016/j.jacl.2020.12.005] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 12/07/2020] [Indexed: 12/21/2022]
Abstract
An Expert Panel of the National Lipid Association reviewed the evidence related to the use of coronary artery calcium (CAC) scoring in clinical practice for adults seen for primary prevention of atherosclerotic cardiovascular disease. Recommendations for optimal use of this test in adults of various races/ethnicities, ages and multiple domains of primary prevention, including those with a 10-year ASCVD risk <20%, those with diabetes or the metabolic syndrome, and those with severe hypercholesterolemia were provided. Recommendations were also made on optimal timing for repeat calcium scoring after an initial test, use of CAC scoring in those taking statins, and its role in informing the clinician patient discussion on the benefit of aspirin and anti-hypertensive drug therapy. Finally, a vision is provided for the future of coronary calcium scoring.
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Affiliation(s)
- Carl E Orringer
- University of Miami, Miller School of Medicine, Cardiovascular Division.
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease
| | - Ron Blankstein
- Brigham and Women's Hospital, Harvard Medical School, Cardiovascular Division
| | | | - Ronald B Goldberg
- Diabetes Research Institute, University of Miami Miller School of Medicine
| | - Edward A Gill
- University of Colorado School of Medicine, Anschutz Campus
| | - Kevin C Maki
- Department of Applied Health Science, School of Public Health, and Midwest Biomedical Research, Indiana University
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Razavi AC, Wong N, Budoff M, Bazzano LA, Kelly TN, He J, Fernandez C, Lima J, Polak JF, Mongraw-Chaffin M, deFilippi C, Szklo M, Bertoni AG, Blumenthal RS, Blaha MJ, Whelton SP. Predicting Long-Term Absence of Coronary Artery Calcium in Metabolic Syndrome and Diabetes: The MESA Study. JACC Cardiovasc Imaging 2021; 14:219-229. [PMID: 33129732 PMCID: PMC7796947 DOI: 10.1016/j.jcmg.2020.06.047] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/21/2020] [Accepted: 06/04/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The purpose of this study was to identify predictors of healthy arterial aging (long-term coronary artery calcification [CAC] of 0) among individuals with metabolic syndrome (MetS) or type 2 diabetes (T2D), which may improve primary prevention strategies. BACKGROUND Individuals with MetS or T2D have a heterogeneously increased risk of atherosclerotic cardiovascular disease and not all have a high-intermediate risk. METHODS We included 574 participants from the MESA (Multi-Ethnic Study of Atherosclerosis) with MetS or T2D who had CAC=0 at baseline and a repeat CAC scan 10 years later. Multivariable logistic regression assessed the association of traditional and novel atherosclerotic cardiovascular disease risk factors and the MetS severity score (based on the 5 MetS criteria) with healthy arterial aging. RESULTS The mean age of participants was 58.9 years, 67% were women, 422 participants had MetS, and 152 had T2D. The proportion with long-term CAC=0 was similar for MetS (42%) and T2D (44%). A younger age was the only individual low/normal traditional risk factor associated with an increased likelihood of long-term CAC=0 (odds ratio [OR]: 1.50; 95% confidence interval [CI]: 1.22 to 1.85 per 10-years younger). The strongest associations of nontraditional risk factors were observed for an absence of thoracic calcification (OR: 2.42; 95% CI: 1.24 to 4.72), absence of carotid plaque (OR: 1.81; 95% CI: 1.25 to 2.61), and among persons with a high sensitivity troponin <3 ng/ml (OR: 1.55; 95% CI: 1.01 to 2.38). In addition, persons with the lowest quartile MetS severity score had a substantially higher odds of healthy long-term CAC=0 (OR: 2.71; 95% CI: 1.27 to 5.76). CONCLUSIONS More than 40% of adults with MetS or T2D and baseline CAC=0 had long-term absence of CAC, which was most strongly associated with an absence of extracoronary atherosclerosis and a low MetS score. An optimal overall cardiovascular profile appears to be more important than an ideal value of any individual risk factor to maintain healthy arterial aging.
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Affiliation(s)
- Alexander C Razavi
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Nathan Wong
- University of California Irvine School of Medicine, Irvine, California
| | - Matthew Budoff
- Los Angeles Biomedical Research Center, Torrance, California
| | - Lydia A Bazzano
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Tanika N Kelly
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Camilo Fernandez
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Joao Lima
- Johns Hopkins University School of Medicine, Division of Cardiology, Baltimore, Maryland
| | | | | | | | - Moyses Szklo
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, Maryland
| | - Alain G Bertoni
- Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Roger S Blumenthal
- The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael J Blaha
- The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Seamus P Whelton
- The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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20
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Doris MK, Meah MN, Moss AJ, Andrews JPM, Bing R, Gillen R, Weir N, Syed M, Daghem M, Shah A, Williams MC, van Beek EJR, Forsyth L, Dey D, Slomka PJ, Dweck MR, Newby DE, Adamson PD. Coronary 18F-Fluoride Uptake and Progression of Coronary Artery Calcification. Circ Cardiovasc Imaging 2020; 13:e011438. [PMID: 33297761 PMCID: PMC7771641 DOI: 10.1161/circimaging.120.011438] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Supplemental Digital Content is available in the text. Background Positron emission tomography (PET) using 18F-sodium fluoride (18F-fluoride) to detect microcalcification may provide insight into disease activity in coronary atherosclerosis. This study aimed to investigate the relationship between 18F-fluoride uptake and progression of coronary calcification in patients with clinically stable coronary artery disease. Methods Patients with established multivessel coronary atherosclerosis underwent 18F-fluoride PET-computed tomography angiography and computed tomography calcium scoring, with repeat computed tomography angiography and calcium scoring at one year. Coronary PET uptake was analyzed qualitatively and semiquantitatively in diseased vessels by measuring maximum tissue-to-background ratio. Coronary calcification was quantified by measuring calcium score, mass, and volume. Results In a total of 183 participants (median age 66 years, 80% male), 116 (63%) patients had increased 18F-fluoride uptake in at least one vessel. Individuals with increased 18F-fluoride uptake demonstrated more rapid progression of calcification compared with those without uptake (change in calcium score, 97 [39–166] versus 35 [7–93] AU; P<0.0001). Indeed, the calcium score only increased in coronary segments with 18F-fluoride uptake (from 95 [30–209] to 148 [61–289] AU; P<0.001) and remained unchanged in segments without 18F-fluoride uptake (from 46 [16–113] to 49 [20–115] AU; P=0.329). Baseline coronary 18F-fluoride maximum tissue-to-background ratio correlated with 1-year change in calcium score, calcium volume, and calcium mass (Spearman ρ=0.37, 0.38, and 0.46, respectively; P<0.0001 for all). At the segmental level, baseline 18F-fluoride activity was an independent predictor of calcium score at 12 months (P<0.001). However, at the patient level, this was not independent of age, sex, and baseline calcium score (P=0.50). Conclusions Coronary 18F-fluoride uptake identifies both patients and individual coronary segments with more rapid progression of coronary calcification, providing important insights into disease activity within the coronary circulation. At the individual patient level, total calcium score remains an important marker of disease burden and progression. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02110303.
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Affiliation(s)
- Mhairi K Doris
- British Heart Foundation Centre for Cardiovascular Science (M.K.D., M.N.M., A.J.M., J.P.M.A., R.B., M.S., M.D., A.S., M.C.W., E.J.R.v.B., M.R.D., D.E.N., P.D.A.), University of Edinburgh, United Kingdom
| | - Mohammed N Meah
- British Heart Foundation Centre for Cardiovascular Science (M.K.D., M.N.M., A.J.M., J.P.M.A., R.B., M.S., M.D., A.S., M.C.W., E.J.R.v.B., M.R.D., D.E.N., P.D.A.), University of Edinburgh, United Kingdom
| | - Alastair J Moss
- British Heart Foundation Centre for Cardiovascular Science (M.K.D., M.N.M., A.J.M., J.P.M.A., R.B., M.S., M.D., A.S., M.C.W., E.J.R.v.B., M.R.D., D.E.N., P.D.A.), University of Edinburgh, United Kingdom
| | - Jack P M Andrews
- British Heart Foundation Centre for Cardiovascular Science (M.K.D., M.N.M., A.J.M., J.P.M.A., R.B., M.S., M.D., A.S., M.C.W., E.J.R.v.B., M.R.D., D.E.N., P.D.A.), University of Edinburgh, United Kingdom
| | - Rong Bing
- British Heart Foundation Centre for Cardiovascular Science (M.K.D., M.N.M., A.J.M., J.P.M.A., R.B., M.S., M.D., A.S., M.C.W., E.J.R.v.B., M.R.D., D.E.N., P.D.A.), University of Edinburgh, United Kingdom
| | - Rebecca Gillen
- Edinburgh Imaging, Queen's Medical Research Institute University of Edinburgh, Edinburgh, United Kingdom (Rebecca Gillen, Nick Weir, Michelle C Williams, Edwin JR van Beek, David E Newby)
| | - Nick Weir
- Edinburgh Imaging, Queen's Medical Research Institute University of Edinburgh, Edinburgh, United Kingdom (Rebecca Gillen, Nick Weir, Michelle C Williams, Edwin JR van Beek, David E Newby)
| | - Maaz Syed
- British Heart Foundation Centre for Cardiovascular Science (M.K.D., M.N.M., A.J.M., J.P.M.A., R.B., M.S., M.D., A.S., M.C.W., E.J.R.v.B., M.R.D., D.E.N., P.D.A.), University of Edinburgh, United Kingdom
| | - Marwa Daghem
- British Heart Foundation Centre for Cardiovascular Science (M.K.D., M.N.M., A.J.M., J.P.M.A., R.B., M.S., M.D., A.S., M.C.W., E.J.R.v.B., M.R.D., D.E.N., P.D.A.), University of Edinburgh, United Kingdom
| | - Anoop Shah
- British Heart Foundation Centre for Cardiovascular Science (M.K.D., M.N.M., A.J.M., J.P.M.A., R.B., M.S., M.D., A.S., M.C.W., E.J.R.v.B., M.R.D., D.E.N., P.D.A.), University of Edinburgh, United Kingdom
| | - Michelle C Williams
- British Heart Foundation Centre for Cardiovascular Science (M.K.D., M.N.M., A.J.M., J.P.M.A., R.B., M.S., M.D., A.S., M.C.W., E.J.R.v.B., M.R.D., D.E.N., P.D.A.), University of Edinburgh, United Kingdom.,Edinburgh Imaging, Queen's Medical Research Institute University of Edinburgh, Edinburgh, United Kingdom (Rebecca Gillen, Nick Weir, Michelle C Williams, Edwin JR van Beek, David E Newby)
| | - Edwin J R van Beek
- British Heart Foundation Centre for Cardiovascular Science (M.K.D., M.N.M., A.J.M., J.P.M.A., R.B., M.S., M.D., A.S., M.C.W., E.J.R.v.B., M.R.D., D.E.N., P.D.A.), University of Edinburgh, United Kingdom.,Edinburgh Imaging, Queen's Medical Research Institute University of Edinburgh, Edinburgh, United Kingdom (Rebecca Gillen, Nick Weir, Michelle C Williams, Edwin JR van Beek, David E Newby)
| | - Laura Forsyth
- Edinburgh Clinical Trials Unit (L.F.), University of Edinburgh, United Kingdom
| | - Damini Dey
- Division of Nuclear Medicine, Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA (D.D., P.J.S.)
| | - Piotr J Slomka
- Division of Nuclear Medicine, Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA (D.D., P.J.S.)
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science (M.K.D., M.N.M., A.J.M., J.P.M.A., R.B., M.S., M.D., A.S., M.C.W., E.J.R.v.B., M.R.D., D.E.N., P.D.A.), University of Edinburgh, United Kingdom
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science (M.K.D., M.N.M., A.J.M., J.P.M.A., R.B., M.S., M.D., A.S., M.C.W., E.J.R.v.B., M.R.D., D.E.N., P.D.A.), University of Edinburgh, United Kingdom.,Edinburgh Imaging, Queen's Medical Research Institute University of Edinburgh, Edinburgh, United Kingdom (Rebecca Gillen, Nick Weir, Michelle C Williams, Edwin JR van Beek, David E Newby)
| | - Philip D Adamson
- British Heart Foundation Centre for Cardiovascular Science (M.K.D., M.N.M., A.J.M., J.P.M.A., R.B., M.S., M.D., A.S., M.C.W., E.J.R.v.B., M.R.D., D.E.N., P.D.A.), University of Edinburgh, United Kingdom.,Christchurch Heart Institute, University of Otago, Christchurch, NZ (P.D.A.)
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21
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de Ronde MW, Khoshiwal A, Planken RN, Boekholdt SM, Biemond M, Budoff MJ, Cooil B, Lotufo PA, Bensenor IM, Ohmoto-Sekine Y, Gudnason V, Aspelund T, Gudmundsson EF, Zwinderman AH, Raggi P, Pinto-Sietsma SJ. A pooled-analysis of age and sex based coronary artery calcium scores percentiles. J Cardiovasc Comput Tomogr 2020; 14:414-420. [DOI: 10.1016/j.jcct.2020.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 01/23/2020] [Indexed: 01/07/2023]
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Cardoso R, Generoso G, Staniak HL, Foppa M, Duncan BB, Pereira AC, Blaha MJ, Blankstein R, Nasir K, Bensenor IM, Lotufo PA, Bittencourt MS. Predictors of coronary artery calcium incidence and progression: The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Atherosclerosis 2020; 309:8-15. [PMID: 32858396 DOI: 10.1016/j.atherosclerosis.2020.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/20/2020] [Accepted: 07/09/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS There are limited data on serial coronary artery calcium (CAC) assessments outside North American and European populations. We sought to investigate risk factors for CAC incidence and progression in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). METHODS We included individuals with no prior cardiovascular disease and two CAC measurements in ELSA-Brasil. Incident CAC was defined as a baseline CAC of 0 followed by CAC >0 on the second study. CAC progression was defined according to multiple published criteria. We performed logistic and linear regression to identify risk factors for CAC incidence and progression. We also examined risk factor effect modification by baseline CAC (0 vs. >0). RESULTS A total of 2707 individuals were included (57% women, age 48.6 ± 7.7 years). Participants self-identified as white (55%), brown (24%), black (16%), Asian (4%) and Indigenous (1%). The mean period between CAC assessments was 5.1 ± 0.9 years. CAC incidence occurred in 282 (13.3%) of 2127 individuals with baseline CAC of 0. CAC progression occurred in 319 (55%) of 580 participants with baseline CAC >0. Risk factors for CAC incidence included older age, male sex, white race, hypertension, diabetes, higher BMI, smoking, lower HDL-C, higher LDL-C and triglycerides, and metabolic syndrome. Older age and elevated LDL-C were associated with CAC incidence, but not progression. Risk factors consistently associated with CAC progression were hypertension, diabetes, hypertriglyceridemia, and metabolic syndrome. On interaction testing, these four risk factors were more strongly associated with CAC progression as compared to CAC incidence. CONCLUSIONS CAC incidence was associated with multiple traditional risk factors, whereas the only risk factors associated with progression of CAC were hypertension, diabetes, hypertriglyceridemia, and metabolic syndrome.
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Affiliation(s)
- Rhanderson Cardoso
- The Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Giuliano Generoso
- Center for Clinical and Epidemiological Research, University Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Henrique L Staniak
- Center for Clinical and Epidemiological Research, University Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Murilo Foppa
- Division of Cardiology, Postgraduate Program in Epidemiology and Hospital de Clínicas de Porto Alegre, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
| | - Bruce B Duncan
- Division of Cardiology, Postgraduate Program in Epidemiology and Hospital de Clínicas de Porto Alegre, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
| | - Alexandre C Pereira
- Instituto Do Coração (InCor), Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Michael J Blaha
- The Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Ron Blankstein
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Khurram Nasir
- Division of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Isabela M Bensenor
- Center for Clinical and Epidemiological Research, University Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Paulo A Lotufo
- Center for Clinical and Epidemiological Research, University Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Marcio S Bittencourt
- Center for Clinical and Epidemiological Research, University Hospital, University of Sao Paulo, Sao Paulo, Brazil.
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High-pitch dual-source CT for coronary artery calcium scoring: A head-to-head comparison of non-triggered chest versus triggered cardiac acquisition. J Cardiovasc Comput Tomogr 2020; 15:65-72. [PMID: 32505593 DOI: 10.1016/j.jcct.2020.04.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 04/28/2020] [Accepted: 04/30/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND To determine the effect of low-dose, high-pitch non-electrocardiographic (ECG)-triggered chest CT on coronary artery calcium (CAC) detection, quantification and risk stratification, compared to ECG-triggered cardiac CT. METHODS We selected 1,000 participants from the ImaLife study, 50% with coronary calcification on cardiac CT. All participants underwent non-contrast cardiac CT followed by chest CT using third-generation dual-source technology. Reconstruction settings were equal for both acquisitions. CAC scores were determined by Agatston's method, and divided dichotomously (0, >0), and into risk categories (0, 1-99, 100-399, ≥400). We investigated the influence of heart rate and body mass index (BMI) on risk reclassification. RESULTS Positive CAC scores on cardiac CT ranged from 1 to 6926 (median 39). Compared to cardiac CT, chest CT had sensitivity of 0.96 (95%CI 0.94-0.98) and specificity of 0.99 (95%CI 0.97-0.99) for CAC detection (κ = 0.95). In participants with coronary calcification on cardiac CT, CAC score on chest CT was lower than on cardiac CT (median 30 versus 40, p˂0.001). Agreement in CAC-based risk strata was excellent (weighted κ = 0.95). Sixty-five cases (6.5%) were reclassified by one risk category in chest CT, with fifty-five (84.6%) shifting downward. Higher BMI resulted in higher reclassification rate (13% for BMI ≥30 versus 5.2% for BMI <30, p = 0.001), but there was no effect of heart rate. CONCLUSION Low-dose, high-pitch chest CT, using third-generation dual-source technology shows almost perfect agreement with cardiac CT in CAC detection and risk stratification. However, low-dose chest CT mainly underestimates the CAC score as compared to cardiac CT, and results in inaccurate risk categorization in BMI ≥30.
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Carr JJ, Jacobs DR, Terry JG, Shay CM, Sidney S, Liu K, Schreiner PJ, Lewis CE, Shikany JM, Reis JP, Goff DC. Association of Coronary Artery Calcium in Adults Aged 32 to 46 Years With Incident Coronary Heart Disease and Death. JAMA Cardiol 2019; 2:391-399. [PMID: 28196265 DOI: 10.1001/jamacardio.2016.5493] [Citation(s) in RCA: 231] [Impact Index Per Article: 46.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Coronary artery calcium (CAC) is associated with coronary heart disease (CHD) and cardiovascular disease (CVD); however, prognostic data on CAC are limited in younger adults. Objective To determine if CAC in adults aged 32 to 46 years is associated with incident clinical CHD, CVD, and all-cause mortality during 12.5 years of follow-up. Design, Setting, and Participants The Coronary Artery Risk Development in Young Adults (CARDIA) Study is a prospective community-based study that recruited 5115 black and white participants aged 18 to 30 years from March 25, 1985, to June 7, 1986. The cohort has been under surveillance for 30 years, with CAC measured 15 (n = 3043), 20 (n = 3141), and 25 (n = 3189) years after recruitment. The mean follow-up period for incident events was 12.5 years, from the year 15 computed tomographic scan through August 31, 2014. Main Outcomes and Measures Incident CHD included fatal or nonfatal myocardial infarction, acute coronary syndrome without myocardial infarction, coronary revascularization, or CHD death. Incident CVD included CHD, stroke, heart failure, and peripheral arterial disease. Death included all causes. The probability of developing CAC by age 32 to 56 years was estimated using clinical risk factors measured 7 years apart between ages 18 and 38 years. Results At year 15 of the study among 3043 participants (mean [SD] age, 40.3 [3.6] years; 1383 men and 1660 women), 309 individuals (10.2%) had CAC, with a geometric mean Agatston score of 21.6 (interquartile range, 17.3-26.8). Participants were followed up for 12.5 years, with 57 incident CHD events and 108 incident CVD events observed. After adjusting for demographics, risk factors, and treatments, those with any CAC experienced a 5-fold increase in CHD events (hazard ratio [HR], 5.0; 95% CI, 2.8-8.7) and 3-fold increase in CVD events (HR, 3.0; 95% CI, 1.9-4.7). Within CAC score strata of 1-19, 20-99, and 100 or more, the HRs for CHD were 2.6 (95% CI, 1.0-5.7), 5.8 (95% CI, 2.6-12.1), and 9.8 (95% CI, 4.5-20.5), respectively. A CAC score of 100 or more had an incidence of 22.4 deaths per 100 participants (HR, 3.7; 95% CI, 1.5-10.0); of the 13 deaths in participants with a CAC score of 100 or more, 10 were adjudicated as CHD events. Risk factors for CVD in early adult life identified those above the median risk for developing CAC and, if applied, in a selective CAC screening strategy could reduce the number of people screened for CAC by 50% and the number imaged needed to find 1 person with CAC from 3.5 to 2.2. Conclusions and Relevance The presence of CAC among individuals aged between 32 and 46 years was associated with increased risk of fatal and nonfatal CHD during 12.5 years of follow-up. A CAC score of 100 or more was associated with early death. Adults younger than 50 years with any CAC, even with very low scores, identified on a computed tomographic scan are at elevated risk of clinical CHD, CVD, and death. Selective use of screening for CAC might be considered in individuals with risk factors in early adulthood to inform discussions about primary prevention.
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Affiliation(s)
- John Jeffrey Carr
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - James G Terry
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Christina M Shay
- Center for Health Metrics and Evaluation, American Heart Association, Dallas, Texas
| | - Stephen Sidney
- Division of Research, Kaiser Permanente, Oakland, California
| | - Kiang Liu
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - Cora E Lewis
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham
| | - James M Shikany
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham
| | - Jared P Reis
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - David C Goff
- Department of Epidemiology, Colorado School of Public Health, Aurora
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Bittencourt MS, Blankstein R, Blaha MJ, Sandfort V, Agatston AS, Budoff MJ, Blumenthal RS, Krumholz HM, Nasir K. Implications of coronary artery calcium testing on risk stratification for lipid-lowering therapy according to the 2016 European Society of Cardiology recommendations: The MESA study. Eur J Prev Cardiol 2018; 25:1887-1898. [PMID: 30043629 DOI: 10.1177/2047487318788930] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS The European Society of Cardiology (ESC) guideline on cardiovascular risk assessment considers coronary artery calcium a class B indication for risk assessment. We evaluated the degree to which coronary artery calcium can change the recommendation for individuals based on a change in estimated risk. METHODS AND RESULTS We stratified 5602 MESA participants according to the ESC recommendation as: no lipid-lowering treatment recommended ( N = 2228), consider lipid-lowering treatment if uncontrolled ( N = 1686), or lipid-lowering treatment recommended ( N = 1688). We evaluated the ability of coronary artery calcium to reclassify cardiovascular risk. Among the selected sample, 54% had coronary artery calcium of zero, 25% had coronary artery calcium of 1-100 and 21% had coronary artery calcium greater than 100. In the lipid-lowering treatment recommended group 31% had coronary artery calcium of zero, while in the lipid-lowering treatment if uncontrolled group about 50% had coronary artery calcium of zero. The cardiovascular mortality rate was 1.7%/10 years in the lipid-lowering treatment if uncontrolled, and 7.0%/10 years in the lipid-lowering treatment recommended group. The absence of coronary artery calcium was associated with 1.4%/10 years in the lipid-lowering treatment if uncontrolled group and 3.0%/10 years in the lipid-lowering treatment recommended group. Compared with coronary artery calcium of zero, any coronary artery calcium was associated with significantly higher cardiovascular mortality in the lipid-lowering treatment recommended group (9.0%/10 years), whereas only coronary artery calcium greater than 100 was significantly associated with a higher cardiovascular mortality in the lipid-lowering treatment if uncontrolled group (3.2%/10 years). CONCLUSION The absence of coronary artery calcium is associated with a low incidence of cardiovascular mortality or coronary heart disease events even in individuals in whom lipid-lowering therapy is recommended. A significant proportion of individuals deemed to be candidates for lipid-lowering therapy might be reclassified to a lower risk group with the use of coronary artery calcium.
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Affiliation(s)
- Marcio S Bittencourt
- 1 Preventive Medicine Center Hospital, Israelita Albert Einstein and School of Medicine, Brazil.,2 Center for Clinical and Epidemiological Research, University of São Paulo, Brazil
| | - Ron Blankstein
- 3 Cardiovascular Imaging Program, Brigham and Women's Hospital and Harvard Medical School, USA
| | - Michael J Blaha
- 4 The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, USA
| | | | - Arthur S Agatston
- 6 Center for Prevention and Wellness Research, Baptist Health Medical Group, USA
| | - Matthew J Budoff
- 7 Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, USA
| | - Roger S Blumenthal
- 4 The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, USA
| | - Harlan M Krumholz
- 8 Section of Cardiovascular Medicine and Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, USA.,9 Section of Health Policy and Administration, Yale School of Public Health, USA.,10 Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, USA
| | - Khurram Nasir
- 4 The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, USA
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Budoff MJ, Young R, Burke G, Jeffrey Carr J, Detrano RC, Folsom AR, Kronmal R, Lima JAC, Liu KJ, McClelland RL, Michos E, Post WS, Shea S, Watson KE, Wong ND. Ten-year association of coronary artery calcium with atherosclerotic cardiovascular disease (ASCVD) events: the multi-ethnic study of atherosclerosis (MESA). Eur Heart J 2018; 39:2401-2408. [PMID: 29688297 PMCID: PMC6030975 DOI: 10.1093/eurheartj/ehy217] [Citation(s) in RCA: 360] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 03/01/2018] [Accepted: 04/03/2018] [Indexed: 12/15/2022] Open
Abstract
Aims While coronary artery calcium (CAC) has been extensively validated for predicting clinical events, most outcome studies of CAC have evaluated coronary heart disease (CHD) rather than atherosclerotic cardiovascular disease (ASCVD) events (including stroke). Also, virtually all CAC studies are of short- or intermediate-term follow-up, so studies across multi-ethnic cohorts with long-term follow-up are warranted prior to widespread clinical use. We sought to evaluate the contribution of CAC using the population-based MESA cohort with over 10 years of follow-up for ASCVD events, and whether the association of CAC with events varied by sex, race/ethnicity, or age category. Methods and results We utilized MESA, a prospective multi-ethnic cohort study of 6814 participants (51% women), aged 45-84 years, free of clinical CVD at baseline. We evaluated the relationship between CAC and incident ASCVD using Cox regression models adjusted for age, race/ethnicity, sex, education, income, cigarette smoking status, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, diabetes, lipid-lowering medication, systolic blood pressure, antihypertensive medication, intentional physical exercise, and body mass index. Only the first event for each individual was used in the analysis. Overall, 500 incident ASCVD (7.4%) events were observed in the total study population over a median of 11.1 years. Hard ASCVD included 217 myocardial infarction, 188 strokes (not transient ischaemic attack), 13 resuscitated cardiac arrest, and 82 CHD deaths. Event rates in those with CAC = 0 Agatston units ranged from 1.3% to 5.6%, while for those with CAC > 300, the 10-year event rates ranged from 13.1% to 25.6% across different age, gender, and racial subgroups. At 10 years of follow-up, all participants with CAC > 100 were estimated to have >7.5% risk regardless of demographic subset. Ten-year ASCVD event rates increased steadily across CAC categories regardless of age, sex, or race/ethnicity. For each doubling of CAC, we estimated a 14% relative increment in ASCVD risk, holding all other risk factors constant. This association was not significantly modified by age, sex, race/ethnicity, or baseline lipid-lowering use. Conclusions Coronary artery calcium is associated strongly and in a graded fashion with 10-year risk of incident ASCVD as it is for CHD, independent of standard risk factors, and similarly by age, gender, and ethnicity. While 10-year event rates in those with CAC = 0 were almost exclusively below 5%, those with CAC ≥ 100 were consistently above 7.5%, making these potentially valuable cutpoints for the consideration of preventive therapies. Coronary artery calcium strongly predicts risk with the same magnitude of effect in all races, age groups, and both sexes, which makes it among the most useful markers for predicting ASCVD risk.
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Affiliation(s)
- Matthew J Budoff
- Los Angeles Biomedical Research Institute, 1124 W Carson Street, CDCRC, Torrance, CA, USA
| | - Rebekah Young
- Department of Biostatistics, University of Washington, Bldg. 29, Suite 310, 6200 NE 74th Street, Seattle, WA, USA
| | - Gregory Burke
- Department of Public Health Sciences, Wake Forest University Health Sciences, 475 Vine St, Winston-Salem, NC, USA
| | - J Jeffrey Carr
- Department of Radiological Sciences, Vanderbilt University, 2525 West End, Nashville, TN, USA
| | - Robert C Detrano
- Departments of Radiological Sciences and Public Health, University of California, Irvine, Irvine, CA, USA
| | - Aaron R Folsom
- Department of Public Health, University of Minnesota, 1300 S 2nd St, Minneapolis, MN, USA
| | - Richard Kronmal
- Department of Biostatistics, University of Washington, Bldg. 29, Suite 310, 6200 NE 74th Street, Seattle, WA, USA
| | - Joao A C Lima
- Department of Internal Medicine, Johns Hopkins University, 600 N Wolfe St, Baltimore, MD, USA
| | - Kiang J Liu
- Department of Preventive Medicine, Northwestern University, 600 N Lake Shore Drive, Chicago, IL, USA
| | - Robyn L McClelland
- Department of Biostatistics, University of Washington, Bldg. 29, Suite 310, 6200 NE 74th Street, Seattle, WA, USA
| | - Erin Michos
- Department of Internal Medicine, Johns Hopkins University, 600 N Wolfe St, Baltimore, MD, USA
| | - Wendy S Post
- Department of Internal Medicine, Johns Hopkins University, 600 N Wolfe St, Baltimore, MD, USA
| | - Steven Shea
- Department of Medicine, Vagelos College of Physicians & Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, 630 W. 168th Street, New York, NY, USA
| | - Karol E Watson
- Department of Internal Medicine, UCLA, 200 UCLA Medical Plaza, Los Angeles, CA, USA
| | - Nathan D Wong
- Departments of Radiological Sciences and Public Health, University of California, Irvine, Irvine, CA, USA
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Vonder M, Vliegenthart R, Kaatee MA, van der Aalst CM, van Ooijen PMA, de Bock GH, Gratama JW, Kuijpers D, de Koning HJ, Oudkerk M. High-pitch versus sequential mode for coronary calcium in individuals with a high heart rate: Potential for dose reduction. J Cardiovasc Comput Tomogr 2018; 12:298-304. [PMID: 29551663 DOI: 10.1016/j.jcct.2018.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/09/2018] [Accepted: 02/26/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND To determine the impact of high-pitch spiral acquisition on radiation dose and cardiovascular disease (CVD) risk stratification by coronary artery calcium (CAC) assessment with computed tomography in individuals with a high heart rate. METHODS Of the ROBINSCA trial, 1990 participants with regular rhythm and heart rates >65 beats per minute (bpm) were included. As reference, 390 participants with regular heart rates ≤65 bpm were used. All participants underwent prospectively electrocardiographically(ECG)-triggered imaging of the coronary arteries using dual source CT at 120 kVp, 80 ref mAs using both high-pitch spiral mode and sequential mode. Radiation dose, Agatston score, number of positive scores, as well as median absolute difference of the Agatston score were determined and participants were stratified into CVD risk categories. RESULTS A similar percentage of participants with low heart rates and high heart rates had a positive CAC score in data sets acquired in high-pitch spiral (low heart rate: 57.7%, high heart rate: 55.8%) and sequential mode (58.0%, 54.7%, p = n.s.). The median absolute difference in Agatston scores between acquisition modes was 14.2% and 9.2%, for the high and low heart rate groups, respectively. Excellent agreement for risk categorization between the two data acquisition modes was found for the high (κ = 0.927) and low (κ = 0.946) heart rate groups. Radiation dose was 48% lower for high-pitch spiral versus sequential acquisitions. CONCLUSION Radiation dose for the quantification of coronary calcium can be reduced by 48% when using the high-pitch spiral acquisition mode compared to the sequential mode in participants with a regular high heart rate. CVD risk stratification agreement between the two modes of data acquisition is excellent.
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Affiliation(s)
- Marleen Vonder
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging North-East Netherlands (CMI-NEN), Groningen, The Netherlands.
| | - Rozemarijn Vliegenthart
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging North-East Netherlands (CMI-NEN), Groningen, The Netherlands.
| | - Merel A Kaatee
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging North-East Netherlands (CMI-NEN), Groningen, The Netherlands.
| | | | - Peter M A van Ooijen
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging North-East Netherlands (CMI-NEN), Groningen, The Netherlands.
| | - Geertruida H de Bock
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, The Netherlands.
| | - Jan Willem Gratama
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging North-East Netherlands (CMI-NEN), Groningen, The Netherlands; Gelre Ziekenhuizen, Dept. of Radiology, Apeldoorn, The Netherlands.
| | - Dirkjan Kuijpers
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging North-East Netherlands (CMI-NEN), Groningen, The Netherlands; HMC-Bronovo, Dept. of Radiology, The Hague, The Netherlands.
| | | | - Matthijs Oudkerk
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging North-East Netherlands (CMI-NEN), Groningen, The Netherlands.
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Divers J, Palmer ND, Langefeld CD, Brown WM, Lu L, Hicks PJ, Smith SC, Xu J, Terry JG, Register TC, Wagenknecht LE, Parks JS, Ma L, Chan GC, Buxbaum SG, Correa A, Musani S, Wilson JG, Taylor HA, Bowden DW, Carr JJ, Freedman BI. Genome-wide association study of coronary artery calcified atherosclerotic plaque in African Americans with type 2 diabetes. BMC Genet 2017; 18:105. [PMID: 29221444 PMCID: PMC5723099 DOI: 10.1186/s12863-017-0572-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 11/23/2017] [Indexed: 11/26/2022] Open
Abstract
Background Coronary artery calcified atherosclerotic plaque (CAC) predicts cardiovascular disease (CVD). Despite exposure to more severe conventional CVD risk factors, African Americans (AAs) are less likely to develop CAC, and when they do, have markedly lower levels than European Americans. Genetic factors likely contribute to the observed ethnic differences. To identify genes associated with CAC in AAs with type 2 diabetes (T2D), a genome-wide association study (GWAS) was performed using the Illumina 5 M chip in 691 African American-Diabetes Heart Study participants (AA-DHS), with replication in 205 Jackson Heart Study (JHS) participants with T2D. Genetic association tests were performed on the genotyped and 1000 Genomes-imputed markers separately for each study, and combined in a meta-analysis. Results Single nucleotide polymorphisms (SNPs), rs11353135 (2q22.1), rs16879003 (6p22.3), rs5014012, rs58071836 and rs10244825 (all on chromosome 7), rs10918777 (9q31.2), rs13331874 (16p13.3) and rs4459623 (18q12.1) were associated with presence and/or quantity of CAC in the AA-DHS and JHS, with meta-analysis p-values ≤8.0 × 10−7. The strongest result in AA-DHS alone was rs6491315 in the 13q32.1 region (parameter estimate (SE) = −1.14 (0.20); p-value = 9.1 × 10−9). This GWAS peak replicated a previously reported AA-DHS CAC admixture signal (rs7492028, LOD score 2.8). Conclusions Genetic association between SNPs on chromosomes 2, 6, 7, 9, 16 and 18 and CAC were detected in AAs with T2D from AA-DHS and replicated in the JHS. These data support a role for genetic variation on these chromosomes as contributors to CAC in AAs with T2D, as well as to variation in CAC between populations of African and European ancestry. Electronic supplementary material The online version of this article (10.1186/s12863-017-0572-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jasmin Divers
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1053, USA.
| | - Nicholette D Palmer
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Carl D Langefeld
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1053, USA
| | - W Mark Brown
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1053, USA
| | - Lingyi Lu
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1053, USA
| | - Pamela J Hicks
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - S Carrie Smith
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jianzhao Xu
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - James G Terry
- Department of Radiology and Vanderbilt Center for Translation and Clinical Cardiovascular Research (VTRACC), Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Thomas C Register
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Lynne E Wagenknecht
- Department of Epidemiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - John S Parks
- Department of Internal Medicine-Section on Molecular Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Lijun Ma
- Department of Internal Medicine-Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Gary C Chan
- Department of Internal Medicine-Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Sarah G Buxbaum
- School of Public Health Initiative, Jackson State University, Jackson, MS, USA
| | | | | | - James G Wilson
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, MS, USA
| | - Herman A Taylor
- Morehouse School of Medicine, Morehouse College, Atlanta, Georgia
| | - Donald W Bowden
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - John Jeffrey Carr
- Department of Radiology and Vanderbilt Center for Translation and Clinical Cardiovascular Research (VTRACC), Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Barry I Freedman
- Department of Internal Medicine-Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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VanWagner LB, Ning H, Allen NB, Ajmera V, Lewis CE, Carr JJ, Lloyd-Jones DM, Terrault NA, Siddique J. Alcohol Use and Cardiovascular Disease Risk in Patients With Nonalcoholic Fatty Liver Disease. Gastroenterology 2017; 153:1260-1272.e3. [PMID: 28802566 PMCID: PMC5669829 DOI: 10.1053/j.gastro.2017.08.012] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 07/19/2017] [Accepted: 08/01/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Cardiovascular disease (CVD) is the leading cause of death among patients with nonalcoholic fatty liver disease (NAFLD). Moderate drinking (vs abstinence) is associated with lower risk of CVD in the general population. We assessed whether alcohol use is associated with CVD risk in patients with NAFLD. METHODS We analyzed data from participants in the Coronary Artery Risk Development in Young Adults longitudinal cohort study of 5115 black and white young adults, 18-30 years old, recruited from 4 cities in the United States from 1985 through 1986. Participants self-reported alcohol use at study entry and then again after 15, 20, and 25 years. At year 25 (2010-2011), participants underwent computed tomography examination of the thorax and abdomen and tissue Doppler echocardiography with myocardial strain measured by speckle tracking. Coronary artery calcification was defined as an Agatston score above 0. NAFLD was defined as liver attenuation <51 Hounsfield Units after exclusions. Drinkers reported 1-21 (men) or 1-14 (women) standard drinks/week at years 15, 20, or 25. Nondrinkers reported no alcohol use at years 15, 20, and 25. RESULTS Of the 570 participants with NAFLD (mean age, 50 years; 54% black; 46% female), 332 (58%) were drinkers; significantly higher proportions of drinkers were white, male, and with higher levels of education compared with nondrinkers (P < .05 for all). Higher proportions of drinkers had obesity, diabetes, and metabolic syndrome compared with nondrinkers (P < .01). There was no difference in liver attenuation between groups (P = .12). After multivariable adjustment, there was no association between alcohol use and CVD risk factors (diabetes, hypertension, hyperlipidemia) or subclinical CVD measures (coronary artery calcification, early transmitral velocity/late (atrial) transmitral velocity (E/A) ratio, global longitudinal strain). CONCLUSIONS In a population-based sample of individuals with NAFLD in midlife, prospectively assessed alcohol use is not associated with significant differences in risk factors for CVD or markers of subclinical CVD. In contrast to general population findings, alcohol use may not reduce the risk of CVD in patients with NAFLD.
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Affiliation(s)
- Lisa B VanWagner
- Department of Medicine, Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Hongyan Ning
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Veeral Ajmera
- Department of Medicine, Division of Gastroenterology & Hepatology, University of California San Francisco, California
| | - Cora E Lewis
- Department of Medicine, Division of Preventive Medicine, University of Alabama Birmingham, Alabama
| | - John Jeffrey Carr
- Department of Radiology, Vanderbilt University, Nashville, Tennessee
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Medicine, Division of Gastroenterology & Hepatology, University of California San Francisco, California
| | - Norah A Terrault
- Department of Medicine, Division of Gastroenterology & Hepatology, University of California San Francisco, California
| | - Juned Siddique
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Robinson TW, Freedman BI. The Apolipoprotein L1 Gene and Cardiovascular Disease. Methodist Debakey Cardiovasc J 2017; 12:2-5. [PMID: 28298955 DOI: 10.14797/mdcj-12-4s1-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Relative to those with European ancestry, African Americans have an excess incidence of nondiabetic chronic kidney disease predominantly due to two coding renal-risk variants in the apolipoprotein L1 gene (APOL1). This APOL1-kidney disease association is independent of systemic hypertension or blood pressure. Recent reports describe extra-renal effects of the APOL1 G1 and G2 renal-risk variants on cardiovascular disease (CVD), subclinical atherosclerosis, lipoprotein particle concentrations, and survival. However, results have been less consistent than those seen in kidney disease, and the observed APOL1 associations with CVD vary from risk to protective. This manuscript reviews the relationships between APOL1 renal-risk variants and CVD, with an emphasis on study-specific factors that may have contributed to disparate observations. It is possible that APOL1 renal-risk variants impact the systemic vasculature, not only the kidneys. As novel therapies for APOL1-associated nephropathy are developed, APOL1 variant protein effects on large blood vessels and risk of CVD will need to be considered.
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Affiliation(s)
- Todd W Robinson
- Wake Forest School of Medicine, Winston-Salem, North Carolina
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Harrington J, Mody P, Blankstein R, Nasir K, Blaha MJ, Joshi PH. Coronary Artery Calcium Testing in Patients with Chest Pain: Alive and Kicking. CURRENT CARDIOVASCULAR RISK REPORTS 2017. [DOI: 10.1007/s12170-017-0542-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Progression of coronary artery calcium in Japanese American men and white men in the ERA JUMP study. Int J Cardiol 2017; 228:672-676. [PMID: 27883980 DOI: 10.1016/j.ijcard.2016.11.238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 11/05/2016] [Accepted: 11/10/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Progression of coronary artery calcium (CAC) is associated with increased risk of coronary heart disease (CHD) and is reported to be greater in whites than blacks, Hispanics, and Chinese in the US. Our objective was to compare progression of CAC between Japanese Americans and whites. METHODS Population-based sample of 303 Japanese American men and 310 white men aged 40-49years, free of clinical cardiovascular disease at baseline, were examined for CAC at baseline (2004-2007) and follow-up (2008-2013). Progression of CAC was defined as change in coronary calcium scores (CCS) in participants with baseline CCS>0 and incident CAC in participants with baseline CCS=0. Multiple linear regression and relative risk regression were used to compare change in CCS scores and incident CAC between the two races, respectively. RESULTS Japanese American men had significantly greater annual change in CCS than white men (median [interquartile range]: 11.3 Agatston units [1.4, 24.9] vs 2.5 [-0.22, 14.5]) in the unadjusted analyses. After adjusting for cardiovascular risk factors and follow-up time, change in CCS (beta±CI) and incidence rate ratio of CAC was similar in Japanese American men and white men: -0.12 (-0.34, 0.15) and (0.87 [95% CI: 0.20, 3.9]), respectively. CONCLUSIONS In contrast to previously reported greater progression of CAC in whites than other races, we found a similar progression of CAC in Japanese American men as white men. Our study identifies Japanese American men as a target group for prevention of CHD. Large prospective studies are warranted to confirm these findings.
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Zaid M, Fujiyoshi A, Kadota A, Abbott RD, Miura K. Coronary Artery Calcium and Carotid Artery Intima Media Thickness and Plaque: Clinical Use in Need of Clarification. J Atheroscler Thromb 2016; 24:227-239. [PMID: 27904029 PMCID: PMC5383538 DOI: 10.5551/jat.rv16005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Atherosclerosis begins in early life and has a long latent period prior to onset of clinical disease. Measures of subclinical atherosclerosis, therefore, may have important implications for research and clinical practice of atherosclerotic cardiovascular disease (ASCVD). In this review, we focus on coronary artery calcium (CAC) and carotid artery intima-media thickness (cIMT) and plaque as many population-based studies have investigated these measures due to their non-invasive features and ease of administration. To date, a vast majority of studies have been conducted in the US and European countries, in which both CAC and cIMT/plaque have been shown to be associated with future risk of ASCVD, independent of conventional risk factors. Furthermore, these measures improve risk prediction when added to a global risk prediction model, such as the Framingham risk score. However, no clinical trial has assessed whether screening with CAC or cIMT/plaque will lead to improved clinical outcomes and healthcare costs. Interestingly, similar levels of CAC or cIMT/plaque among various regions and ethnic groups may in fact be associated with significantly different levels of absolute risk of ASCVD. Therefore, it remains to be determined whether measures of subclinical atherosclerosis improve risk prediction in non-US/European populations. Although CAC and cIMT/plaque are promising surrogates of ASCVD in research, we conclude that their use in clinical practice, especially as screening tools for primary prevention in asymptomatic adults, is premature due to many vagaries that remain to be clarified.
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Affiliation(s)
- Maryam Zaid
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science
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Impact of Advanced Modeled Iterative Reconstruction on Coronary Artery Calcium Quantification. Acad Radiol 2016; 23:1506-1512. [PMID: 27742177 DOI: 10.1016/j.acra.2016.08.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 07/27/2016] [Accepted: 08/02/2016] [Indexed: 12/17/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the influence of advanced modeled iterative reconstruction (ADMIRE) on the coronary artery calcium (CAC) scores by computed tomography (CT). MATERIALS AND METHODS Sixty patients underwent CAC imaging with dual-source 192-slice CT. Agatston, volume and mass score were calculated from filtered back projection (FBP) and iterative reconstructions with different levels of ADMIRE. Friedman test and Wilcoxon rank sum test were used for multiple comparisons of CAC values and the difference ratio among different ADMIRE groups using FBP as reference. RESULTS The median Agatston score (range) using FBP was 115 (0.1-3047) and significantly decreased with incremental ADMIRE levels 1-5: 96 (0.1-2813), 91 (0-2764), 87 (0-2699), 80 (0-2590), 70 (0-2440); all P < 0.001. In comparison with FBP Agatston, volume and mass scores significantly decreased with increasing ADMIRE levels 1-5 (P < 0.001): from -12% to -39%, from -14% to -41%, and from -13% to -40%, respectively. In four patients with low calcium burden, the use of ADMIRE 2 or higher resulted in the disappearance of calcium that was detectable using FBP or ADMIRE 1. The decrease of CAC in high-level ADMIRE resulted in a reassignment to a lower Agatston risk group in 27%. CONCLUSIONS ADMIRE causes a substantial reduction of the CAC scores measured by cardiac CT, which leads to an underestimation of cardiovascular risk scores in some patients.
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Kaufman JD, Adar SD, Barr RG, Budoff M, Burke GL, Curl CL, Daviglus ML, Diez Roux AV, Gassett AJ, Jacobs DR, Kronmal R, Larson TV, Navas-Acien A, Olives C, Sampson PD, Sheppard L, Siscovick DS, Stein JH, Szpiro AA, Watson KE. Association between air pollution and coronary artery calcification within six metropolitan areas in the USA (the Multi-Ethnic Study of Atherosclerosis and Air Pollution): a longitudinal cohort study. Lancet 2016; 388:696-704. [PMID: 27233746 PMCID: PMC5019949 DOI: 10.1016/s0140-6736(16)00378-0] [Citation(s) in RCA: 347] [Impact Index Per Article: 43.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Long-term exposure to fine particulate matter less than 2.5 μm in diameter (PM2.5) and traffic-related air pollutant concentrations are associated with cardiovascular risk. The disease process underlying these associations remains uncertain. We aim to assess association between long-term exposure to ambient air pollution and progression of coronary artery calcium and common carotid artery intima-media thickness. METHODS In this prospective 10-year cohort study, we repeatedly measured coronary artery calcium by CT in 6795 participants aged 45-84 years enrolled in the Multi-Ethnic Study of Atherosclerosis and Air Pollution (MESA Air) in six metropolitan areas in the USA. Repeated scans were done for nearly all participants between 2002 and 2005, for a subset of participants between 2005 and 2007, and for half of all participants between 2010 and 2012. Common carotid artery intima-media thickness was measured by ultrasound in all participants at baseline and in 2010-12 for 3459 participants. Residence-specific spatio-temporal pollution concentration models, incorporating community-specific measurements, agency monitoring data, and geographical predictors, estimated concentrations of PM2.5 and nitrogen oxides (NOX) between 1999 and 2012. The primary aim was to examine the association between both progression of coronary artery calcium and mean carotid artery intima-media thickness and long-term exposure to ambient air pollutant concentrations (PM2.5, NOX, and black carbon) between examinations and within the six metropolitan areas, adjusting for baseline age, sex, ethnicity, socioeconomic characteristics, cardiovascular risk factors, site, and CT scanner technology. FINDINGS In this population, coronary calcium increased on average by 24 Agatston units per year (SD 58), and intima-media thickness by 12 μm per year (10), before adjusting for risk factors or air pollutant exposures. Participant-specific pollutant concentrations averaged over the years 2000-10 ranged from 9.2-22.6 μg PM2.5/m(3) and 7.2-139.2 parts per billion (ppb) NOX. For each 5 μg PM2.5/m(3) increase, coronary calcium progressed by 4.1 Agatston units per year (95% CI 1.4-6.8) and for each 40 ppb NOX coronary calcium progressed by 4.8 Agatston units per year (0.9-8.7). Pollutant exposures were not associated with intima-media thickness change. The estimate for the effect of a 5 μg/m(3) higher long-term exposure to PM2.5 in intima-media thickness was -0.9 μm per year (95% CI -3.0 to 1.3). For 40 ppb higher NOX, the estimate was 0.2 μm per year (-1.9 to 2.4). INTERPRETATION Increased concentrations of PM2.5 and traffic-related air pollution within metropolitan areas, in ranges commonly encountered worldwide, are associated with progression in coronary calcification, consistent with acceleration of atherosclerosis. This study supports the case for global efforts of pollution reduction in prevention of cardiovascular diseases. FUNDING US Environmental Protection Agency and US National Institutes of Health.
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Affiliation(s)
- Joel D Kaufman
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA.
| | - Sara D Adar
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - R Graham Barr
- Department of Medicine and Department of Epidemiology, Columbia University, New York, NY, USA
| | - Matthew Budoff
- Los Angeles Biomedical Research Institute at Harbor, UCLA Medical Center, Torrance, CA, USA
| | - Gregory L Burke
- Division of Public Health Sciences, Wake Forest University, Winston-Salem, NC, USA
| | - Cynthia L Curl
- Department of Community and Environmental Health, Boise State University, Boise, ID, USA
| | - Martha L Daviglus
- Feinberg School of Medicine, Northwestern University, Evanston, IL, USA; Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL, USA
| | - Ana V Diez Roux
- School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Amanda J Gassett
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - David R Jacobs
- School of Public Health, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Richard Kronmal
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Timothy V Larson
- Department of Civil and Environmental Engineering, University of Washington, Seattle, WA, USA
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Casey Olives
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Paul D Sampson
- Department of Statistics, University of Washington, Seattle, WA, USA
| | - Lianne Sheppard
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA; Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - David S Siscovick
- Department of Medicine, University of Washington, Seattle, WA, USA; New York Academy of Medicine, New York, NY, USA
| | - James H Stein
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Adam A Szpiro
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Karol E Watson
- Department of Medicine, Division of Cardiology, University of California Los Angeles, Los Angeles, CA, USA
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Yuan M, Hsu FC, Bowden DW, Xu J, Smith SC, Wagenknecht LE, Comeau ME, Divers J, Register TC, Carr JJ, Langefeld CD, Freedman BI. Relationships between measures of adiposity with subclinical atherosclerosis in patients with type 2 diabetes. Obesity (Silver Spring) 2016; 24:1810-8. [PMID: 27356020 PMCID: PMC4963287 DOI: 10.1002/oby.21540] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 04/06/2016] [Accepted: 04/06/2016] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Assess cross-sectional relationships between body mass index (BMI), waist circumference (WC), pericardial (PAT), visceral (VAT), and subcutaneous adipose tissue (SAT) volumes with calcified plaque (CP) in African Americans (AAs) and European Americans (EAs) with type 2 diabetes. METHODS Computed tomography measured PAT, VAT, SAT, and CP in coronary arteries (CAC), carotid arteries, and aorta. Generalized estimating equations models were fitted to test for associations between adiposity and CP, stratified by ethnicity while accounting for familial correlations. RESULTS AAs (N = 753) vs. EAs (N = 562) had significantly lower PAT and VAT, despite equal or higher BMI. In multivariable models adjusting for age, gender, education, HbA1c, statins, smoking, cardiovascular disease, hypertension, nephropathy, and C-reactive protein, PAT positively associated with presence of CAC in AAs (P < 0.001), not EAs (P = 0.68; ethnicity interaction P < 0.01). Inverse associations were detected between SAT and severity of aorta CP (P < 0.01) in AAs and between BMI, WC, and SAT with severity of aorta CP in all participants. CONCLUSIONS Ethnic- and gender-specific differences in BMI, WC, PAT, SAT, and VAT were present in AAs and EAs with diabetes. Only PAT was positively associated with CAC in AAs; paradoxical inverse associations were seen between several other adiposity measures and subclinical cardiovascular disease.
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Affiliation(s)
- Mingxia Yuan
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Centers for Genomics and Personalized Medicine Research & Diabetes Research, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Fang-Chi Hsu
- Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Donald W. Bowden
- Centers for Genomics and Personalized Medicine Research & Diabetes Research, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jianzhao Xu
- Centers for Genomics and Personalized Medicine Research & Diabetes Research, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - S. Carrie Smith
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Lynne E. Wagenknecht
- Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Mary E. Comeau
- Centers for Genomics and Personalized Medicine Research & Diabetes Research, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jasmin Divers
- Centers for Genomics and Personalized Medicine Research & Diabetes Research, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Thomas C. Register
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - J. Jeffrey Carr
- Department of Radiology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Carl D. Langefeld
- Centers for Genomics and Personalized Medicine Research & Diabetes Research, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Barry I. Freedman
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Centers for Genomics and Personalized Medicine Research & Diabetes Research, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Gidding SS, Rana JS, Prendergast C, McGill H, Carr JJ, Liu K, Colangelo LA, Loria CM, Lima J, Terry JG, Reis JP, McMahan CA. Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Risk Score in Young Adults Predicts Coronary Artery and Abdominal Aorta Calcium in Middle Age: The CARDIA Study. Circulation 2016; 133:139-46. [PMID: 27028434 PMCID: PMC4817359 DOI: 10.1161/circulationaha.115.018042] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 10/23/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND We explored whether, the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) coronary and abdominal risk scores measured at 18 to 30 years of age and changes in these scores would more strongly predict coronary artery calcium (CAC) and abdominal aortic calcium (AAC) assessed 25 years later, than scores measured 25 years later. METHODS AND RESULTS In the Coronary Artery Risk Development in Young Adults (CARDIA) study, 3008 participants had measurements of risk score components at 5-year intervals beginning at 18 to 30 years of age. CAC and AAC were assessed at 43 to 55 years of age. Odds ratios (ORs) for the presence and extent of CAC/AAC per/point higher score and c-statistics for predicting CAC/AAC were calculated. The prevalence of CAC was 28% and AAC was 53%. For each 1 point higher PDAY score, the odds of CAC were higher using baseline scores than year 25 scores (OR, 1.29; 95% confidence interval [CI], 1.25-1.33 versus OR, 1.12; 95% CI, 1.11-1.14). For AAC, ORs at years 0 and 25 were similar (OR, 1.29; 95% CI, 1.24-1.34 versus OR, 1.22; 95% CI, 1.19-1.26). C-statistic for CAC prediction was higher at year 0 than year 25 (0.731 versus 0.705) but similar at years 0 and 25 for AAC (0.665 versus 0.670). ORs for CAC were highest at baseline, and, for AAC, ORs were highest at year 10. Including change in PDAY scores with baseline scores improved prediction. CONCLUSIONS Atherosclerosis risk and change in risk assessed in young adulthood years before subclinical atherosclerosis imaging provide strong prediction of future subclinical atherosclerosis. CAC and AAC reflect chronic risk exposure in addition to risk measured at the time of study.
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Affiliation(s)
- Samuel S Gidding
- From Nemours Cardiac Center, A. I. DuPont Hospital for Children, Wilmington, DE (S.S.G.); Divisions of Cardiology and Research, Kaiser Permanente Northern California, Oakland, (J.S.R.); Department of Medicine, University of California, San Francisco (J.S.R.); Division of Pediatric Cardiology, Vanderbilt University, Nashville, TN (C.P.); Department of Pathology, University of Texas Health Sciences Center, San Antonio (H.M., C.A.M.); Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center (VTRACC), Vanderbilt University, Nashville, TN (J.J.C., J.G.T.); Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (K.L., L.A.C.); Division of Cardiovascular Science, National Heart Lung and Blood Institute, Bethesda, MD (C.M.L., J.P.R.); and Department of Internal Medicine, Johns Hopkins University Hospital, Baltimore, MD (J.L.).
| | - Jamal S Rana
- From Nemours Cardiac Center, A. I. DuPont Hospital for Children, Wilmington, DE (S.S.G.); Divisions of Cardiology and Research, Kaiser Permanente Northern California, Oakland, (J.S.R.); Department of Medicine, University of California, San Francisco (J.S.R.); Division of Pediatric Cardiology, Vanderbilt University, Nashville, TN (C.P.); Department of Pathology, University of Texas Health Sciences Center, San Antonio (H.M., C.A.M.); Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center (VTRACC), Vanderbilt University, Nashville, TN (J.J.C., J.G.T.); Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (K.L., L.A.C.); Division of Cardiovascular Science, National Heart Lung and Blood Institute, Bethesda, MD (C.M.L., J.P.R.); and Department of Internal Medicine, Johns Hopkins University Hospital, Baltimore, MD (J.L.)
| | - Christopher Prendergast
- From Nemours Cardiac Center, A. I. DuPont Hospital for Children, Wilmington, DE (S.S.G.); Divisions of Cardiology and Research, Kaiser Permanente Northern California, Oakland, (J.S.R.); Department of Medicine, University of California, San Francisco (J.S.R.); Division of Pediatric Cardiology, Vanderbilt University, Nashville, TN (C.P.); Department of Pathology, University of Texas Health Sciences Center, San Antonio (H.M., C.A.M.); Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center (VTRACC), Vanderbilt University, Nashville, TN (J.J.C., J.G.T.); Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (K.L., L.A.C.); Division of Cardiovascular Science, National Heart Lung and Blood Institute, Bethesda, MD (C.M.L., J.P.R.); and Department of Internal Medicine, Johns Hopkins University Hospital, Baltimore, MD (J.L.)
| | - Henry McGill
- From Nemours Cardiac Center, A. I. DuPont Hospital for Children, Wilmington, DE (S.S.G.); Divisions of Cardiology and Research, Kaiser Permanente Northern California, Oakland, (J.S.R.); Department of Medicine, University of California, San Francisco (J.S.R.); Division of Pediatric Cardiology, Vanderbilt University, Nashville, TN (C.P.); Department of Pathology, University of Texas Health Sciences Center, San Antonio (H.M., C.A.M.); Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center (VTRACC), Vanderbilt University, Nashville, TN (J.J.C., J.G.T.); Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (K.L., L.A.C.); Division of Cardiovascular Science, National Heart Lung and Blood Institute, Bethesda, MD (C.M.L., J.P.R.); and Department of Internal Medicine, Johns Hopkins University Hospital, Baltimore, MD (J.L.)
| | - J Jeffery Carr
- From Nemours Cardiac Center, A. I. DuPont Hospital for Children, Wilmington, DE (S.S.G.); Divisions of Cardiology and Research, Kaiser Permanente Northern California, Oakland, (J.S.R.); Department of Medicine, University of California, San Francisco (J.S.R.); Division of Pediatric Cardiology, Vanderbilt University, Nashville, TN (C.P.); Department of Pathology, University of Texas Health Sciences Center, San Antonio (H.M., C.A.M.); Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center (VTRACC), Vanderbilt University, Nashville, TN (J.J.C., J.G.T.); Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (K.L., L.A.C.); Division of Cardiovascular Science, National Heart Lung and Blood Institute, Bethesda, MD (C.M.L., J.P.R.); and Department of Internal Medicine, Johns Hopkins University Hospital, Baltimore, MD (J.L.)
| | - Kiang Liu
- From Nemours Cardiac Center, A. I. DuPont Hospital for Children, Wilmington, DE (S.S.G.); Divisions of Cardiology and Research, Kaiser Permanente Northern California, Oakland, (J.S.R.); Department of Medicine, University of California, San Francisco (J.S.R.); Division of Pediatric Cardiology, Vanderbilt University, Nashville, TN (C.P.); Department of Pathology, University of Texas Health Sciences Center, San Antonio (H.M., C.A.M.); Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center (VTRACC), Vanderbilt University, Nashville, TN (J.J.C., J.G.T.); Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (K.L., L.A.C.); Division of Cardiovascular Science, National Heart Lung and Blood Institute, Bethesda, MD (C.M.L., J.P.R.); and Department of Internal Medicine, Johns Hopkins University Hospital, Baltimore, MD (J.L.)
| | - Laura A Colangelo
- From Nemours Cardiac Center, A. I. DuPont Hospital for Children, Wilmington, DE (S.S.G.); Divisions of Cardiology and Research, Kaiser Permanente Northern California, Oakland, (J.S.R.); Department of Medicine, University of California, San Francisco (J.S.R.); Division of Pediatric Cardiology, Vanderbilt University, Nashville, TN (C.P.); Department of Pathology, University of Texas Health Sciences Center, San Antonio (H.M., C.A.M.); Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center (VTRACC), Vanderbilt University, Nashville, TN (J.J.C., J.G.T.); Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (K.L., L.A.C.); Division of Cardiovascular Science, National Heart Lung and Blood Institute, Bethesda, MD (C.M.L., J.P.R.); and Department of Internal Medicine, Johns Hopkins University Hospital, Baltimore, MD (J.L.)
| | - Catherine M Loria
- From Nemours Cardiac Center, A. I. DuPont Hospital for Children, Wilmington, DE (S.S.G.); Divisions of Cardiology and Research, Kaiser Permanente Northern California, Oakland, (J.S.R.); Department of Medicine, University of California, San Francisco (J.S.R.); Division of Pediatric Cardiology, Vanderbilt University, Nashville, TN (C.P.); Department of Pathology, University of Texas Health Sciences Center, San Antonio (H.M., C.A.M.); Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center (VTRACC), Vanderbilt University, Nashville, TN (J.J.C., J.G.T.); Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (K.L., L.A.C.); Division of Cardiovascular Science, National Heart Lung and Blood Institute, Bethesda, MD (C.M.L., J.P.R.); and Department of Internal Medicine, Johns Hopkins University Hospital, Baltimore, MD (J.L.)
| | - Joao Lima
- From Nemours Cardiac Center, A. I. DuPont Hospital for Children, Wilmington, DE (S.S.G.); Divisions of Cardiology and Research, Kaiser Permanente Northern California, Oakland, (J.S.R.); Department of Medicine, University of California, San Francisco (J.S.R.); Division of Pediatric Cardiology, Vanderbilt University, Nashville, TN (C.P.); Department of Pathology, University of Texas Health Sciences Center, San Antonio (H.M., C.A.M.); Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center (VTRACC), Vanderbilt University, Nashville, TN (J.J.C., J.G.T.); Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (K.L., L.A.C.); Division of Cardiovascular Science, National Heart Lung and Blood Institute, Bethesda, MD (C.M.L., J.P.R.); and Department of Internal Medicine, Johns Hopkins University Hospital, Baltimore, MD (J.L.)
| | - James G Terry
- From Nemours Cardiac Center, A. I. DuPont Hospital for Children, Wilmington, DE (S.S.G.); Divisions of Cardiology and Research, Kaiser Permanente Northern California, Oakland, (J.S.R.); Department of Medicine, University of California, San Francisco (J.S.R.); Division of Pediatric Cardiology, Vanderbilt University, Nashville, TN (C.P.); Department of Pathology, University of Texas Health Sciences Center, San Antonio (H.M., C.A.M.); Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center (VTRACC), Vanderbilt University, Nashville, TN (J.J.C., J.G.T.); Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (K.L., L.A.C.); Division of Cardiovascular Science, National Heart Lung and Blood Institute, Bethesda, MD (C.M.L., J.P.R.); and Department of Internal Medicine, Johns Hopkins University Hospital, Baltimore, MD (J.L.)
| | - Jared P Reis
- From Nemours Cardiac Center, A. I. DuPont Hospital for Children, Wilmington, DE (S.S.G.); Divisions of Cardiology and Research, Kaiser Permanente Northern California, Oakland, (J.S.R.); Department of Medicine, University of California, San Francisco (J.S.R.); Division of Pediatric Cardiology, Vanderbilt University, Nashville, TN (C.P.); Department of Pathology, University of Texas Health Sciences Center, San Antonio (H.M., C.A.M.); Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center (VTRACC), Vanderbilt University, Nashville, TN (J.J.C., J.G.T.); Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (K.L., L.A.C.); Division of Cardiovascular Science, National Heart Lung and Blood Institute, Bethesda, MD (C.M.L., J.P.R.); and Department of Internal Medicine, Johns Hopkins University Hospital, Baltimore, MD (J.L.)
| | - C Alex McMahan
- From Nemours Cardiac Center, A. I. DuPont Hospital for Children, Wilmington, DE (S.S.G.); Divisions of Cardiology and Research, Kaiser Permanente Northern California, Oakland, (J.S.R.); Department of Medicine, University of California, San Francisco (J.S.R.); Division of Pediatric Cardiology, Vanderbilt University, Nashville, TN (C.P.); Department of Pathology, University of Texas Health Sciences Center, San Antonio (H.M., C.A.M.); Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center (VTRACC), Vanderbilt University, Nashville, TN (J.J.C., J.G.T.); Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (K.L., L.A.C.); Division of Cardiovascular Science, National Heart Lung and Blood Institute, Bethesda, MD (C.M.L., J.P.R.); and Department of Internal Medicine, Johns Hopkins University Hospital, Baltimore, MD (J.L.)
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Nasir K, Bittencourt MS, Blaha MJ, Blankstein R, Agatson AS, Rivera JJ, Miedema MD, Sibley CT, Shaw LJ, Blumenthal RS, Budoff MJ, Krumholz HM. Implications of Coronary Artery Calcium Testing Among Statin Candidates According to American College of Cardiology/American Heart Association Cholesterol Management Guidelines: MESA (Multi-Ethnic Study of Atherosclerosis). J Am Coll Cardiol 2016; 66:1657-68. [PMID: 26449135 DOI: 10.1016/j.jacc.2015.07.066] [Citation(s) in RCA: 342] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 07/20/2015] [Accepted: 07/20/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND The American College of Cardiology (ACC)/American Heart Association (AHA) cholesterol management guidelines have significantly broadened the scope of candidates eligible for statin therapy. OBJECTIVES This study evaluated the implications of the absence of coronary artery calcium (CAC) in reclassifying patients from a risk stratum in which statins are recommended to one in which they are not. METHODS MESA (Multi-Ethnic Study of Atherosclerosis) is a longitudinal study of 6,814 men and women 45 to 84 years of age without clinical atherosclerotic cardiovascular disease (ASCVD) risk at enrollment. We excluded 1,100 participants (16%) on lipid-lowering medication, 87 (1.3%) without low-density lipoprotein levels, 26 (0.4%) with missing risk factors for calculation of 10-year risk of ASCVD, 633 (9%) >75 years of age, and 209 (3%) with low-density lipoprotein <70 mg/dl from the analysis. RESULTS The study population consisted of 4,758 participants (age 59 ± 9 years; 47% males). A total of 247 (5.2%) ASCVD and 155 (3.3%) hard coronary heart disease events occurred over a median (interquartile range) follow-up of 10.3 (9.7 to 10.8) years. The new ACC/AHA guidelines recommended 2,377 (50%) MESA participants for moderate- to high-intensity statins; the majority (77%) was eligible because of a 10-year estimated ASCVD risk ≥7.5%. Of those recommended statins, 41% had CAC = 0 and had 5.2 ASCVD events/1,000 person-years. Among 589 participants (12%) considered for moderate-intensity statin, 338 (57%) had a CAC = 0, with an ASCVD event rate of 1.5 per 1,000 person-years. Of participants eligible (recommended or considered) for statins, 44% (1,316 of 2,966) had CAC = 0 at baseline and an observed 10-year ASCVD event rate of 4.2 per 1,000 person-years. CONCLUSIONS Significant ASCVD risk heterogeneity exists among those eligible for statins according to the new guidelines. The absence of CAC reclassifies approximately one-half of candidates as not eligible for statin therapy.
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Affiliation(s)
- Khurram Nasir
- Center for Healthcare Advancement & Outcomes, Baptist Health South Florida, Miami, Florida; Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, Florida; The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland; Department of Epidemiology, Robert Stempel College of Public Health and Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida.
| | - Marcio S Bittencourt
- Center for Clinical and Epidemiological Research and Division of Internal Medicine, University Hospital, University of São Paulo, São Paulo, Brazil; Non-Invasive Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Preventive Medicine Centre, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Michael J Blaha
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland
| | - Ron Blankstein
- Non-Invasive Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Arthur S Agatson
- Center for Healthcare Advancement & Outcomes, Baptist Health South Florida, Miami, Florida
| | | | | | - Christopher T Sibley
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland Oregon
| | - Leslee J Shaw
- Emory Clinical Cardiovascular Research Institute, Emory University, Atlanta, Georgia
| | - Roger S Blumenthal
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland
| | - Matthew J Budoff
- Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California
| | - Harlan M Krumholz
- Section of Cardiovascular Medicine and Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
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Radiation dose reduction at coronary artery calcium scoring by using a low tube current technique and hybrid iterative reconstruction. J Comput Assist Tomogr 2015; 39:119-24. [PMID: 25319604 DOI: 10.1097/rct.0000000000000168] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to compare the accuracy of coronary artery calcium scoring (CACS) on cardiac computed tomographic images using hybrid iterative reconstruction (hIR) and a low tube current as well as on images acquired with a filtered back projection (FBP) algorithm and a normal tube current. SUBJECTS AND METHODS Patients (N = 77) with suspected coronary artery disease were subjected to 2 CACS evaluations based on their Agatston, volume, and mass scores. One CACS evaluation was performed on images obtained with a 364-mA tube current and reconstructed with FBP; the other was performed on images obtained with a 73-mA tube current and reconstructed with hIR at iDose4. All scans were performed with the prospective electrocardiogram-triggered method using a 256-slice computed tomographic scanner (Brilliance iCT; Philips). We assessed agreement between calcium scores obtained with FBP and with IR using the percentage difference and Bland-Altman analysis. RESULTS The effective radiation doses for CACS at 80 mA s with FBP and at 16 mA s with IR were 1.20 and 0.24 mSv, respectively (k = 0.014). The mean Agatston, volume, and mass scores at 80 mA s with FBP as well as at 16 mA s with IR were 390.7, 146.5, and 63.2 as well as 377.7, 142.5, and 62.2, respectively. The percentage difference between FBP and hIR for the Agatston, volume, and mass score was 20.7%, 20.7%, and 27.1%, respectively. Bland-Altman analysis showed that there was no systemic bias. CONCLUSIONS The radiation dose for CACS can be reduced at a low tube current and hIR without affecting the calcium score.
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Alluri K, Joshi PH, Henry TS, Blumenthal RS, Nasir K, Blaha MJ. Scoring of coronary artery calcium scans: history, assumptions, current limitations, and future directions. Atherosclerosis 2015; 239:109-17. [PMID: 25585030 DOI: 10.1016/j.atherosclerosis.2014.12.040] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 12/17/2014] [Accepted: 12/18/2014] [Indexed: 01/07/2023]
Abstract
Coronary artery calcium (CAC) scanning is a reliable, noninvasive technique for estimating overall coronary plaque burden and for identifying risk for future cardiac events. Arthur Agatston and Warren Janowitz published the first technique for scoring CAC scans in 1990. Given the lack of available data correlating CAC with burden of coronary atherosclerosis at that time, their scoring algorithm was remarkable, but somewhat arbitrary. Since then, a few other scoring techniques have been proposed for the measurement of CAC including the Volume score and Mass score. Yet despite new data, little in this field has changed in the last 15 years. The main focus of our paper is to review the implications of the current approach to scoring CAC scans in terms of correlation with the central disease - coronary atherosclerosis. We first discuss the methodology of each available scoring system, describing how each of these scores make important indirect assumptions in the way they account (or do not account) for calcium density, location of calcium, spatial distribution of calcium, and microcalcification/emerging calcium that might limit their predictive power. These assumptions require further study in well-designed, large event-driven studies. In general, all of these scores are adequate and are highly correlated with each other. Despite its age, the Agatston score remains the most extensively studied and widely accepted technique in both the clinical and research settings. After discussing CAC scoring in the era of contrast enhanced coronary CT angiography, we discuss suggested potential modifications to current CAC scanning protocols with respect to tube voltage, tube current, and slice thickness which may further improve the value of CAC scoring. We close with a focused discussion of the most important future directions in the field of CAC scoring.
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Affiliation(s)
- Krishna Alluri
- Department of Internal Medicine, UPMC Mckeesport Hospital, Mckeesport, PA, USA; The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | - Parag H Joshi
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | - Travis S Henry
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Roger S Blumenthal
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | - Khurram Nasir
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA; Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, FL, USA
| | - Michael J Blaha
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA.
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Hecht HS, de Siqueira MEM, Cham M, Yip R, Narula J, Henschke C, Yankelevitz D. Low- vs. standard-dose coronary artery calcium scanning. Eur Heart J Cardiovasc Imaging 2014; 16:358-63. [DOI: 10.1093/ehjci/jeu218] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Distribution of calcification in carotid endarterectomy tissues: Comparison of micro-computed tomography imaging with histology. Vasc Med 2014; 19:343-50. [DOI: 10.1177/1358863x14549270] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Calcification in atherosclerotic plaques has been viewed as a marker of plaque stability, but whether calcification accumulates in specific anatomic sites in the carotid artery is unknown. We determined the burden and distribution of calcified plaque in carotid endarterectomy (CEA) tissues. Methods: A total of 22 CEA tissues were imaged with high-resolution micro-computed tomography (micro-CT). Total plaque burden and total calcium score using the Agatston method were quantified. The Agatston score (AS) was also normalized for tissue size. Plaque and calcium distribution were analyzed separately for three CEA regions: common segment (CS), bulb segment (BS), and internal/external segments (IES). Results: The average CEA tissue length was 40.83 (interquartile range [IQR] 33.31–42.41) mm with total plaque burden of 103.45 (IQR: 78.84–156.81) mm3 and total AS of 38.58 (IQR 11.59–89.97). Total plaque volume was 21.02 (IQR: 14.47–25.42) mm3 in the CS, 37.89 (22.59–48.32) mm3 in the BS, and 54.05 (36.87–74.52) mm3 in the IES. Of the 22 tissues, 15 had no calcium in the CS compared with three in the bulb and two in the IES. Normalized calcified plaque was most prevalent in the BS, the IES and was least prevalent in the CS. The overall correlation of calcification between histology sections and matched micro-CT images was 0.86 ( p<0.001). Conclusions: Calcified plaque is heterogeneously distributed in CEA tissues with most in the bulb and IES regions. The amount of calcification in micro-CT slices shows a high correlation with matched histology sections.
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Andersson C, Vasan RS. Is there a role for coronary artery calcium scoring for management of asymptomatic patients at risk for coronary artery disease?: Clinical risk scores are sufficient to define primary prevention treatment strategies among asymptomatic patients. Circ Cardiovasc Imaging 2014; 7:390-7; discussion 397. [PMID: 24642921 DOI: 10.1161/circimaging.113.000470] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Charlotte Andersson
- The National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA
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VanWagner LB, Ning H, Lewis CE, Shay CM, Wilkins J, Carr JJ, Terry JG, Lloyd-Jones DM, Jacobs DR, Carnethon MR. Associations between nonalcoholic fatty liver disease and subclinical atherosclerosis in middle-aged adults: the Coronary Artery Risk Development in Young Adults Study. Atherosclerosis 2014; 235:599-605. [PMID: 24956534 PMCID: PMC4124046 DOI: 10.1016/j.atherosclerosis.2014.05.962] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 05/16/2014] [Accepted: 05/29/2014] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Non-alcoholic fatty liver disease (NAFLD) is an obesity-related condition associated with cardiovascular mortality. Yet, whether or not NAFLD is independently related to atherosclerosis is unclear. In a population-based cross-sectional sample of middle-aged adults free from liver or heart disease, we tested the hypothesis that NAFLD is associated with subclinical atherosclerosis (coronary artery (CAC) and abdominal aortic calcification (AAC)) independent of obesity. METHODS Participants from the Coronary Artery Risk Development in Young Adults study with CT quantification of liver fat, CAC and AAC were included (n = 2424). NAFLD was defined as liver attenuation ≤40 Hounsfield Units after exclusion of other causes of liver fat. CAC and AAC presence was defined as Agatston score >0. RESULTS Mean participant age was 50.1 ± 3.6 years, (42.7% men, 50.0% black) and BMI was 30.6 ± 7.2 kg/m(2). The prevalence of NAFLD, CAC, and AAC was 9.6%, 27.1%, and 51.4%. NAFLD participants had increased prevalence of CAC (37.9% vs. 26.0%, p < 0.001) and AAC (65.1% vs. 49.9%, p < 0.001). NAFLD remained associated with CAC (OR, 1.33; 95% CI, 1.001-1.82) and AAC (OR, 1.74; 95% CI, 1.29-2.35) after adjustment for demographics and health behaviors. However, these associations were attenuated after additional adjustment for visceral adipose tissue (CAC OR, 1.05; 95% CI, 0.74-1.48, AAC OR = 1.20; 95% CI, 0.86-1.67). There was no interaction by race or sex. CONCLUSION In contrast to prior research, these findings suggest that obesity attenuates the relationship between NAFLD and subclinical atherosclerosis. Further studies evaluating the role of NAFLD duration on atherosclerotic progression and cardiovascular events are needed.
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Affiliation(s)
- Lisa B VanWagner
- Department of Preventive Medicine, Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Department of Medicine, Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Hongyan Ning
- Department of Preventive Medicine, Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Cora E Lewis
- University of Alabama Birmingham, Birmingham, AL, USA.
| | - Christina M Shay
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
| | - John Wilkins
- Department of Preventive Medicine, Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | | | | | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Forbang NI, Ix JH, Allison MA, Criqui MH. Associations of cardiovascular disease risk factors and calcified atherosclerosis with aortoiliac bifurcation position: the MultiEthnic Study of Atherosclerosis. Angiology 2013; 66:90-5. [PMID: 24375634 DOI: 10.1177/0003319713516669] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We investigated associations of cardiovascular disease (CVD) risk factors and calcified atherosclerosis with aortoiliac bifurcation position. The bifurcation position was determined by measuring the distance from the aortoiliac bifurcation to the L5-S1 disk space (or aortoiliac bifurcation distance [AIBD]), using computed tomography scans. The 1711 study participants (51% male) had a mean age of 62 ± 10 years and a mean AIBD of 26 ± 15 mm. In multivariable linear regression, older age, male gender, smoking, hypertension, larger aortic diameter, and smaller lumbar height were each independently associated with a smaller AIBD (more caudal bifurcation position). In contrast, diabetes, elevated triglycerides, and increased pulse pressure were independently associated with a larger AIBD (more cephalad bifurcation position). These findings suggest that age-related bifurcation descent is associated with CVD markers for aortic disease. Future studies should assess whether the bifurcation position is an independent prognosticator for CVD.
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Affiliation(s)
- Nketi I Forbang
- Department of Family and Preventive Medicine, University of California-San Diego, La Jolla, CA, USA
| | - Joachim H Ix
- Department of Family and Preventive Medicine, University of California-San Diego, La Jolla, CA, USA Department of Medicine, Veterans Administration San Diego Healthcare System, San Diego, CA, USA
| | - Matthew A Allison
- Department of Family and Preventive Medicine, University of California-San Diego, La Jolla, CA, USA
| | - Michael H Criqui
- Department of Family and Preventive Medicine, University of California-San Diego, La Jolla, CA, USA
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Silverman MG, Blaha MJ, Krumholz HM, Budoff MJ, Blankstein R, Sibley CT, Agatston A, Blumenthal RS, Nasir K. Impact of coronary artery calcium on coronary heart disease events in individuals at the extremes of traditional risk factor burden: the Multi-Ethnic Study of Atherosclerosis. Eur Heart J 2013; 35:2232-41. [PMID: 24366919 DOI: 10.1093/eurheartj/eht508] [Citation(s) in RCA: 221] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS We sought to evaluate the impact of coronary artery calcium (CAC) in individuals at the extremes of risk factor (RF) burden. METHODS AND RESULTS 6698 individuals from the Multi-Ethnic Study of Atherosclerosis (MESA) were followed for coronary heart disease (CHD) events over mean 7.1 ± 1 years. Annualized CHD event rates were compared among each RF category (0, 1, 2, or ≥3) after stratification by CAC score (0, 1-100, 101-300, and >300). The following traditional modifiable RFs were considered: cigarette smoking, LDL cholesterol ≥3.4 mmol/L, low HDL cholesterol, hypertension, and diabetes. There were 1067 subjects (16%) with 0 RFs, whereas 1205 (18%) had ≥3 RFs. Among individuals with 0 RFs, 68% had CAC 0, whereas 12 and 5% had CAC >100 and >300, respectively. Among individuals with ≥3 RFs, 35% had CAC 0, whereas 34 and 19% had CAC >100 and >300, respectively. Overall, 339 (5.1%) CHD events occurred. Individuals with 0 RFs and CAC >300 had an event rate 3.5 times higher than individuals with ≥3 RFs and CAC 0 (10.9/1000 vs. 3.1/1000 person-years). Similar results were seen across categories of Framingham risk score. CONCLUSION Among individuals at the extremes of RF burden, the distribution of CAC is heterogeneous. The presence of a high CAC burden, even among individuals without RFs, is associated with an elevated event rate, whereas the absence of CAC, even among those with many RF, is associated with a low event rate. Coronary artery calcium has the potential to further risk stratify asymptomatic individuals at the extremes of RF burden.
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Affiliation(s)
- Michael G Silverman
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA Brigham and Women's Hospital, Cardiovascular Division, Boston, MA, USA
| | - Michael J Blaha
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | - Harlan M Krumholz
- Section of Cardiovascular Medicine and the Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, and Section of Health Policy and Administration, Yale School of Public Health; and the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
| | - Matthew J Budoff
- Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA, USA
| | - Ron Blankstein
- Brigham and Women's Hospital, Cardiovascular Division, Boston, MA, USA
| | | | - Arthur Agatston
- Center for Prevention and Wellness Research, Baptist Health Medical Group, 1691 Michigan Avenue, Suite 500, Miami Beach, FL 33139, USA
| | - Roger S Blumenthal
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | - Khurram Nasir
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA Center for Prevention and Wellness Research, Baptist Health Medical Group, 1691 Michigan Avenue, Suite 500, Miami Beach, FL 33139, USA Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, Florida
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Impact of iterative reconstruction on CT coronary calcium quantification. Eur Radiol 2013; 23:3246-52. [DOI: 10.1007/s00330-013-3022-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 08/31/2013] [Indexed: 01/07/2023]
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Lee MS, Chun EJ, Kim KJ, Kim JA, Yoo JY, Choi SI. Asymptomatic subjects with zero coronary calcium score: coronary CT angiographic features of plaques in event-prone patients. Int J Cardiovasc Imaging 2013; 29 Suppl 1:29-36. [PMID: 23754773 DOI: 10.1007/s10554-013-0257-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 06/05/2013] [Indexed: 01/03/2023]
Abstract
The aims of this study were: (a) to assess clinical predictors and coronary computed tomography angiography (CCTA) characteristics of noncalcified coronary plaques (NCP) in subjects who had cardiac events despite a zero coronary artery calcium score (CACS), and (b) to describe computed tomography (CT) plaque characteristics in subjects with cardiac events. A total of 7,961 subjects with zero CACS were evaluated; 6,531 subjects underwent CCTA as part of a health check-up. Those who had zero CACS were included in our mid-term follow-up study. Cardiac events included cardiac death, acute coronary syndrome or revascularization with stable angina. More than one NCP was identified in 441 subjects with zero CACS, including 48 subjects with obstructive coronary artery disease (CAD) caused by NCPs. Age, male gender, hypertension, diabetes and low density lipoprotein were independent predictors of obstructive CAD. Among subjects with obstructive CAD, young adults were classified into low (79.2 %) or moderate (72.9 %) risk groups by the National Centers for Environmental Prediction III guidelines. Approximately 0.2 % of subjects had cardiac events during our follow-up period. All patients with cardiac events had NCPs with significantly lower mean CT numbers, higher remodeling indexes and worse degree of stenosis. In asymptomatic subjects with zero CACS, NCP was associated with cardiac events. CCTA might be useful for risk stratification among select populations with CAD and zero CACS who have certain plaque characteristics associated with cardiac events.
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Affiliation(s)
- Min Su Lee
- Division of Cardiovascular Imaging, Department of Radiology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bungdang-gu, Seongnam-si, Gyeonggi-do 436-707, Korea
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