George Youssef1, Mengye Guo2, Robyn L McClelland2, David M Shavelle3, Khurram Nasir4, Juan Rivera5, J Jeffrey Carr6, Nathan D Wong7, Matthew J Budoff8. 1. Department of Medicine, LA Biomedical Research Institute at Harbor, UCLA, 1124 West Carson St, Torrance, CA 90502. 2. Department of Biostatistics, University of Washington, Seattle, Washington. 3. Department of Medicine, Harbor, UCLA, Los Angeles, California. 4. Department of Medicine, LA Biomedical Research Institute at Harbor, UCLA, 1124 West Carson St, Torrance, CA 90502; Department of Cardiology, Johns Hopkins University, Baltimore, Maryland; Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, Florida; Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, Florida; Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida. 5. Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland; South Beach Preventive Cardiology, Miami, Florida. 6. Department of Radiology, Wake Forest University, Winston-Salem, North Carolina. 7. Division of Radiology, University of California, Irvine, Irvine, California. 8. Department of Medicine, LA Biomedical Research Institute at Harbor, UCLA, 1124 West Carson St, Torrance, CA 90502. Electronic address: mbudoff@labiomed.org.
Abstract
RATIONALE AND OBJECTIVES: Vascular calcification independently predicts cardiovascular disease (CVD), and computed tomography (CT) is a useful tool to evaluate and quantify not only coronary but also thoracic aortic calcification (TAC). Previous TAC progression reports were limited to dialysis and renal transplant patients. This is the first study to evaluate TAC progression in a large multiethnic cohort without clinically evident CVD at entry. METHODS: Non-contrast-enhanced cardiac CTs were obtained in 5886 of 6814 Multi-Ethnic Study of Atherosclerosis (MESA) participants (mean age, 62 years; 48% males; 40% white, 27% black, 21% Hispanic, and 12% Chinese). Baseline and follow-up TAC scores were derived. RESULTS: Overall, 4308 (73%) participants had no detectable baseline TAC. Mean follow-up duration was 2.4 ± 0.8 years, during which 12% developed TAC. The overall incidence rate was 4.8%/year and was greater with age across gender and ethnic groups; TAC incidence was significantly lower in blacks than whites. After adjustment for follow-up duration, regression analyses showed age, systolic blood pressure, antihypertensives, and smoking were associated with incident TAC. A total of 1578 (27%) participants had TAC at baseline with a positive association between average annual TAC change and baseline age. Although the overall median change was 32.9 (-1.4 to 112.2) Agatston units, 27% showed an annual score change of ≥100 and blacks showed the lowest median across ethnic groups; 22.7 (-3 to 86.8). Age, systolic blood pressure, lipid-lowering medication, diabetes, and smoking were associated with TAC progression. CONCLUSIONS: In MESA, traditional CV risk factors were related to both TAC incidence and progression. Blacks had the lowest incidence and median change across ethnic groups, consistent with previous findings for coronary calcification.
RATIONALE AND OBJECTIVES:Vascular calcification independently predicts cardiovascular disease (CVD), and computed tomography (CT) is a useful tool to evaluate and quantify not only coronary but also thoracic aortic calcification (TAC). Previous TAC progression reports were limited to dialysis and renal transplant patients. This is the first study to evaluate TAC progression in a large multiethnic cohort without clinically evident CVD at entry. METHODS: Non-contrast-enhanced cardiac CTs were obtained in 5886 of 6814 Multi-Ethnic Study of Atherosclerosis (MESA) participants (mean age, 62 years; 48% males; 40% white, 27% black, 21% Hispanic, and 12% Chinese). Baseline and follow-up TAC scores were derived. RESULTS: Overall, 4308 (73%) participants had no detectable baseline TAC. Mean follow-up duration was 2.4 ± 0.8 years, during which 12% developed TAC. The overall incidence rate was 4.8%/year and was greater with age across gender and ethnic groups; TAC incidence was significantly lower in blacks than whites. After adjustment for follow-up duration, regression analyses showed age, systolic blood pressure, antihypertensives, and smoking were associated with incident TAC. A total of 1578 (27%) participants had TAC at baseline with a positive association between average annual TAC change and baseline age. Although the overall median change was 32.9 (-1.4 to 112.2) Agatston units, 27% showed an annual score change of ≥100 and blacks showed the lowest median across ethnic groups; 22.7 (-3 to 86.8). Age, systolic blood pressure, lipid-lowering medication, diabetes, and smoking were associated with TAC progression. CONCLUSIONS: In MESA, traditional CV risk factors were related to both TAC incidence and progression. Blacks had the lowest incidence and median change across ethnic groups, consistent with previous findings for coronary calcification.
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