Alexander C Razavi1, Nathan Wong2, Matthew Budoff3, Lydia A Bazzano1, Tanika N Kelly4, Jiang He1, Camilo Fernandez1, Joao Lima5, Joseph F Polak6, Morgana Mongraw-Chaffin7, Chris deFilippi8, Moyses Szklo9, Alain G Bertoni7, Roger S Blumenthal10, Michael J Blaha10, Seamus P Whelton11. 1. 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. 2. University of California Irvine School of Medicine, Irvine, California. 3. Los Angeles Biomedical Research Center, Torrance, California. 4. Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana. 5. Johns Hopkins University School of Medicine, Division of Cardiology, Baltimore, Maryland. 6. Tufts Medical Center, Boston, Massachusetts. 7. Wake Forest University School of Medicine, Winston-Salem, North Carolina. 8. Inova Heart and Vascular Institute, Falls Church, Maryland. 9. Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, Maryland. 10. The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland. 11. The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: seamus.whelton@jhmi.edu.
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.
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.
Authors: Alexander C Razavi; S M Iftekhar Uddin; Zeina A Dardari; Daniel S Berman; Matthew J Budoff; Michael D Miedema; Albert D Osei; Olufunmilayo H Obisesan; Khurram Nasir; Alan Rozanski; John A Rumberger; Leslee J Shaw; Laurence S Sperling; Seamus P Whelton; Martin Bødtker Mortensen; Michael J Blaha; Omar Dzaye Journal: JACC Cardiovasc Imaging Date: 2022-03-21
Authors: Alexander C Razavi; Lydia A Bazzano; Jiang He; Marie Krousel-Wood; Kirsten S Dorans; Michael A Razavi; Camilo Fernandez; Seamus P Whelton; Tanika N Kelly Journal: Am J Prev Cardiol Date: 2021-05-04
Authors: Alexander C Razavi; Tanika N Kelly; Matthew J Budoff; Lydia A Bazzano; Jiang He; Camilo Fernandez; Joao Lima; Khurram Nasir; Roger S Blumenthal; Michael J Blaha; Seamus P Whelton Journal: Atherosclerosis Date: 2021-03-26 Impact factor: 5.162
Authors: Alexander C Razavi; Lydia A Bazzano; Jiang He; Marie Krousel-Wood; Jing Chen; Camilo Fernandez; Seamus P Whelton; Tanika N Kelly Journal: J Am Heart Assoc Date: 2021-06-05 Impact factor: 5.501