Michael H Criqui1, Jessica B Knox2, Julie O Denenberg2, Nketi I Forbang2, Robyn L McClelland3, Thomas E Novotny4, Veit Sandfort5, Jill Waalen2, Michael J Blaha6, Matthew A Allison2. 1. Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California. Electronic address: mcriqui@ucsd.edu. 2. Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California. 3. Department of Biostatistics, University of Washington, Seattle, Washington. 4. Division of Epidemiology and Biostatistics, San Diego State University, San Diego, California. 5. National Institutes of Health Clinical Center, Department of Radiology and Imaging Sciences, Bethesda, Maryland. 6. Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland.
Abstract
OBJECTIVES: This study sought to determine the possibility of interactions between coronary artery calcium (CAC) volume or CAC density with each other, and with age, sex, ethnicity, the new atherosclerotic cardiovascular disease (ASCVD) risk score, diabetes status, and renal function by estimated glomerular filtration rate, and, using differing CAC scores, to determine the improvement over the ASCVD risk score in risk prediction and reclassification. BACKGROUND: In MESA (Multi-Ethnic Study of Atherosclerosis), CAC volume was positively and CAC density inversely associated with cardiovascular disease (CVD) events. METHODS: A total of 3,398 MESA participants free of clinical CVD but with prevalent CAC at baseline were followed for incident CVD events. RESULTS: During a median 11.0 years of follow-up, there were 390 CVD events, 264 of which were coronary heart disease (CHD). With each SD increase of ln CAC volume (1.62), risk of CHD increased 73% (p < 0.001) and risk of CVD increased 61% (p < 0.001). Conversely, each SD increase of CAC density (0.69) was associated with 28% lower risk of CHD (p < 0.001) and 25% lower risk of CVD (p < 0.001). CAC density was inversely associated with risk at all levels of CAC volume (i.e., no interaction was present). In multivariable Cox models, significant interactions were present for CAC volume with age and ASCVD risk score for both CHD and CVD, and CAC density with ASCVD risk score for CVD. Hazard ratios were generally stronger in the lower risk groups. Receiver-operating characteristic area under the curve and Net Reclassification Index analyses showed better prediction by CAC volume than by Agatston, and the addition of CAC density to CAC volume further significantly improved prediction. CONCLUSIONS: The inverse association between CAC density and incident CHD and CVD events is robust across strata of other CVD risk factors. Added to the ASCVD risk score, CAC volume and density provided the strongest prediction for CHD and CVD events, and the highest correct reclassification.
OBJECTIVES: This study sought to determine the possibility of interactions between coronary artery calcium (CAC) volume or CAC density with each other, and with age, sex, ethnicity, the new atherosclerotic cardiovascular disease (ASCVD) risk score, diabetes status, and renal function by estimated glomerular filtration rate, and, using differing CAC scores, to determine the improvement over the ASCVD risk score in risk prediction and reclassification. BACKGROUND: In MESA (Multi-Ethnic Study of Atherosclerosis), CAC volume was positively and CAC density inversely associated with cardiovascular disease (CVD) events. METHODS: A total of 3,398 MESA participants free of clinical CVD but with prevalent CAC at baseline were followed for incident CVD events. RESULTS: During a median 11.0 years of follow-up, there were 390 CVD events, 264 of which were coronary heart disease (CHD). With each SD increase of ln CAC volume (1.62), risk of CHD increased 73% (p < 0.001) and risk of CVD increased 61% (p < 0.001). Conversely, each SD increase of CAC density (0.69) was associated with 28% lower risk of CHD (p < 0.001) and 25% lower risk of CVD (p < 0.001). CAC density was inversely associated with risk at all levels of CAC volume (i.e., no interaction was present). In multivariable Cox models, significant interactions were present for CAC volume with age and ASCVD risk score for both CHD and CVD, and CAC density with ASCVD risk score for CVD. Hazard ratios were generally stronger in the lower risk groups. Receiver-operating characteristic area under the curve and Net Reclassification Index analyses showed better prediction by CAC volume than by Agatston, and the addition of CAC density to CAC volume further significantly improved prediction. CONCLUSIONS: The inverse association between CAC density and incident CHD and CVD events is robust across strata of other CVD risk factors. Added to the ASCVD risk score, CAC volume and density provided the strongest prediction for CHD and CVD events, and the highest correct reclassification.
Authors: Isac C Thomas; Caroline A Thompson; Mingan Yang; Matthew A Allison; Nketi I Forbang; Erin D Michos; Robyn L McClelland; Matthew J Budoff; Michael H Criqui Journal: Arterioscler Thromb Vasc Biol Date: 2018-08 Impact factor: 8.311
Authors: Borek Foldyna; Parastou Eslami; Jan-Erik Scholtz; Kristin Baltrusaitis; Michael T Lu; Joseph M Massaro; Ralph B D'Agostino; Maros Ferencik; Hugo J W L Aerts; Christopher J O'Donnell; Udo Hoffmann Journal: Eur Radiol Date: 2019-05-02 Impact factor: 5.315
Authors: Omar Dzaye; Alexander C Razavi; Zeina A Dardari; Daniel S Berman; Matthew J Budoff; Michael D Miedema; Olufunmilayo H Obisesan; Ellen Boakye; Khurram Nasir; Alan Rozanski; John A Rumberger; Leslee J Shaw; Martin Bødtker Mortensen; Seamus P Whelton; Michael J Blaha Journal: JACC Cardiovasc Imaging Date: 2021-11-17
Authors: Allison W Peng; Zeina A Dardari; Roger S Blumenthal; Omar Dzaye; Olufunmilayo H Obisesan; S M Iftekhar Uddin; Khurram Nasir; Ron Blankstein; Matthew J Budoff; Martin Bødtker Mortensen; Parag H Joshi; John Page; Michael J Blaha Journal: Circulation Date: 2021-03-02 Impact factor: 29.690
Authors: Kwok Leung Ong; Robyn L McClelland; Matthew A Allison; Mary Cushman; Parveen K Garg; Michael Y Tsai; Kerry-Anne Rye; Fatiha Tabet Journal: Metabolism Date: 2021-01-07 Impact factor: 8.694
Authors: Parastou Eslami; Chintan Parmar; Borek Foldyna; Jan-Erik Scholtz; Alexander Ivanov; Roman Zeleznik; Michael T Lu; Maros Ferencik; Ramachandran S Vasan; Kristin Baltrusaitis; Joseph M Massaro; Ralph B D'Agostino; Thomas Mayrhofer; Christopher J O'Donnell; Hugo J W L Aerts; Udo Hoffmann Journal: Radiol Cardiothorac Imaging Date: 2020-02-27
Authors: Seth B Newman; Vaishnavi Kundel; Mika Matsuzaki; Michelle Reid; Jorge R Kizer; Robert C Kaplan; Zahi A Fayad; Venkatesh Mani; Steven Shea; Matthew Allison; Michael H Criqui; Pamela L Lutsey; Robyn L McClelland; Susan Redline; Neomi A Shah Journal: J Clin Sleep Med Date: 2021-10-01 Impact factor: 4.324