Isac C Thomas1, Robyn L McClelland2, Erin D Michos3, Matthew A Allison4, Nketi I Forbang4, W T Longstreth5, Wendy S Post3, Nathan D Wong6, Matthew J Budoff7, Michael H Criqui4. 1. Division of Preventive Medicine, Department of Family Medicine and Public Health, University of California, San Diego, USA; Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, USA. Electronic address: icthomas@ucsd.edu. 2. Department of Biostatistics, University of Washington, Seattle, USA. 3. Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA. 4. Division of Preventive Medicine, Department of Family Medicine and Public Health, University of California, San Diego, USA. 5. Departments of Neurology and Epidemiology, University of Washington, Seattle, USA. 6. Departments of Neurology and Epidemiology, University of Washington, Seattle, USA; Division of Cardiology, University of California, Irvine, USA. 7. Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-University of California Los Angeles Medical Center, USA.
Abstract
BACKGROUND AND AIMS: The volume and density of coronary artery calcium (CAC) both independently predict cardiovascular disease (CVD) beyond standard risk factors, with CAC density inversely associated with incident CVD after accounting for CAC volume. We tested the hypothesis that ascending thoracic aorta calcium (ATAC) volume and density predict incident CVD events independently of CAC. METHODS: The Multi-Ethnic Study of Atherosclerosis (MESA) is a prospective cohort study of participants without clinical CVD at baseline. ATAC and CAC were measured from baseline cardiac computed tomography (CT). Cox regression models were used to estimate the associations of ATAC volume and density with incident coronary heart disease (CHD) events and CVD events, after adjustment for standard CVD risk factors and CAC volume and density. RESULTS: Among 6811 participants, 234 (3.4%) had prevalent ATAC and 3395 (49.8%) had prevalent CAC. Over 10.3 years, 355 CHD and 562 CVD events occurred. One-standard deviation higher ATAC density was associated with a lower risk of CHD (HR 0.48 [95% CI 0.29-0.79], p<0.01) and CVD (HR 0.56 [0.37-0.84], p<0.01) after full adjustment. ATAC volume was not associated with outcomes after full adjustment. CONCLUSIONS: ATAC was uncommon in a cohort free of clinical CVD at baseline. However, ATAC density was inversely associated with incident CHD and CVD after adjustment for CVD risk factors and CAC volume and density.
BACKGROUND AND AIMS: The volume and density of coronary artery calcium (CAC) both independently predict cardiovascular disease (CVD) beyond standard risk factors, with CAC density inversely associated with incident CVD after accounting for CAC volume. We tested the hypothesis that ascending thoracic aorta calcium (ATAC) volume and density predict incident CVD events independently of CAC. METHODS: The Multi-Ethnic Study of Atherosclerosis (MESA) is a prospective cohort study of participants without clinical CVD at baseline. ATAC and CAC were measured from baseline cardiac computed tomography (CT). Cox regression models were used to estimate the associations of ATAC volume and density with incident coronary heart disease (CHD) events and CVD events, after adjustment for standard CVD risk factors and CAC volume and density. RESULTS: Among 6811 participants, 234 (3.4%) had prevalent ATAC and 3395 (49.8%) had prevalent CAC. Over 10.3 years, 355 CHD and 562 CVD events occurred. One-standard deviation higher ATAC density was associated with a lower risk of CHD (HR 0.48 [95% CI 0.29-0.79], p<0.01) and CVD (HR 0.56 [0.37-0.84], p<0.01) after full adjustment. ATAC volume was not associated with outcomes after full adjustment. CONCLUSIONS: ATAC was uncommon in a cohort free of clinical CVD at baseline. However, ATAC density was inversely associated with incident CHD and CVD after adjustment for CVD risk factors and CAC volume and density.
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