Parag H Joshi1, Birju Patel1, Michael J Blaha2, Jarett D Berry3, Ron Blankstein4, Matthew J Budoff5, Nathan Wong6, Arthur Agatston7, Roger S Blumenthal2, Khurram Nasir8. 1. University of Texas Southwestern Medical Center, Department of Medicine, Division of Cardiology, Dallas, TX, USA; Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA. 2. Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA. 3. University of Texas Southwestern Medical Center, Department of Medicine, Division of Cardiology, Dallas, TX, USA. 4. Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital, Boston, MA, USA. 5. Department of Medicine, Division of Cardiology Harbor-UCLA Medical Center, Torrance, CA, USA. 6. Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, CA, USA. 7. Center for Prevention and Wellness Research, Baptist Health South Florida, Miami, FL, USA. 8. Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA; Center for Prevention and Wellness Research, Baptist Health South Florida, Miami, FL, USA; Department of Medicine, Herbert Wertheim College of Medicine and Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL, USA. Electronic address: Knasir1@jhmi.edu.
Abstract
AIMS: Patients with a low lifetime risk of coronary heart disease (CHD) are not completely free of events over 10 years. We evaluated predictors for CHD among "low lifetime risk" participants in the population-based Multi-Ethnic Study of Atherosclerosis (MESA). METHODS: MESA enrolled 6814 men and women aged 45-84 years who were free of baseline cardiovascular disease. Using established criteria of non-diabetic, non-smokers with total cholesterol ≤ 200 mg/dL, systolic BP ≤ 139 mmHg, and diastolic BP ≤ 89 mmHg at baseline, we identified 1391 participants with a low lifetime risk for cardiovascular disease. Baseline covariates were age, gender, ethnicity, HDL-C, C-reactive protein, family history of CHD, carotid intima-media thickness and coronary artery calcium (CAC). We calculated event rates and the number needed to scan (NNS) to identify one participant with CAC>0 and > 100. RESULTS: Over 10.4 years median follow-up, there were 33 events (2.4%) in participants with low lifetime risk. There were 479 participants (34%) with CAC>0 including 183 (13%) with CAC>100. CAC was present in 25 (76%) participants who experienced an event. In multivariable analyses, only CAC>100 remained predictive of CHD (HR 4.6; 95% CI: 1.6-13.6; p = 0.005). The event rates for CAC = 0, CAC>0 and CAC>100 were 0.9/1,000, 5.7/1,000, and 11.0/1000 person-years, respectively. The NNS to identify one participant with CAC>0 and > 100 were 3 and 7.6, respectively. CONCLUSIONS: While 10-year event rates were low in those with low lifetime risk, CAC was the strongest predictor of incident CHD. Identification of individuals with CAC = 0 and CAC>100 carries significant potential therapeutic implications.
AIMS: Patients with a low lifetime risk of coronary heart disease (CHD) are not completely free of events over 10 years. We evaluated predictors for CHD among "low lifetime risk" participants in the population-based Multi-Ethnic Study of Atherosclerosis (MESA). METHODS: MESA enrolled 6814 men and women aged 45-84 years who were free of baseline cardiovascular disease. Using established criteria of non-diabetic, non-smokers with total cholesterol ≤ 200 mg/dL, systolic BP ≤ 139 mmHg, and diastolic BP ≤ 89 mmHg at baseline, we identified 1391 participants with a low lifetime risk for cardiovascular disease. Baseline covariates were age, gender, ethnicity, HDL-C, C-reactive protein, family history of CHD, carotid intima-media thickness and coronary artery calcium (CAC). We calculated event rates and the number needed to scan (NNS) to identify one participant with CAC>0 and > 100. RESULTS: Over 10.4 years median follow-up, there were 33 events (2.4%) in participants with low lifetime risk. There were 479 participants (34%) with CAC>0 including 183 (13%) with CAC>100. CAC was present in 25 (76%) participants who experienced an event. In multivariable analyses, only CAC>100 remained predictive of CHD (HR 4.6; 95% CI: 1.6-13.6; p = 0.005). The event rates for CAC = 0, CAC>0 and CAC>100 were 0.9/1,000, 5.7/1,000, and 11.0/1000 person-years, respectively. The NNS to identify one participant with CAC>0 and > 100 were 3 and 7.6, respectively. CONCLUSIONS: While 10-year event rates were low in those with low lifetime risk, CAC was the strongest predictor of incident CHD. Identification of individuals with CAC = 0 and CAC>100 carries significant potential therapeutic implications.
Authors: Catherine Kim; Vanita R Aroda; Ronald B Goldberg; Naji Younes; Sharon L Edelstein; MaryLou Carrion-Petersen; David A Ehrmann Journal: J Clin Endocrinol Metab Date: 2018-02-01 Impact factor: 5.958
Authors: Ankur Gupta; Emily Lau; Ravi Varshney; Edward A Hulten; Michael Cheezum; Marcio S Bittencourt; Michael J Blaha; Nathan D Wong; Roger S Blumenthal; Matthew J Budoff; Craig A Umscheid; Khurram Nasir; Ron Blankstein Journal: JACC Cardiovasc Imaging Date: 2017-08
Authors: Jonathan James Hyett Bray; Moghees Ahmad Hanif; Mohammad Alradhawi; Jacob Ibbetson; Surinder Singh Dosanjh; Sabrina Lucy Smith; Mahmood Ahmad; Dominic Pimenta Journal: Eur Heart J Open Date: 2022-03-17
Authors: Hui Gu; Yang Gao; Zhihui Hou; U Joseph Schoepf; Alan N Snyder; Taylor M Duguay; Ximing Wang; Bin Lu Journal: Eur Radiol Date: 2017-09-29 Impact factor: 5.315