Impact of coronary artery calcium on coronary heart disease events in individuals at the extremes of traditional risk factor burden: The Multi-Ethnic Study of Atherosclerosis

Michael G. Silverman, Michael J. Blaha, Harlan M. Krumholz, Matthew J. Budoff, Ron Blankstein, Christopher Sibley, Arthur Agatston, Roger S. Blumenthal, Khurram Nasir

Research output: Contribution to journalArticle

119 Citations (Scopus)

Abstract

Aims: We sought to evaluate the impact of coronary artery calcium (CAC) in individuals at the extremes of risk factor (RF) burden. Methods and results: 6698 individuals from the Multi-Ethnic Study of Atherosclerosis (MESA) were followed for coronary heart disease (CHD) events over mean 7.1 ± 1 years. Annualized CHD event rates were compared among each RF category (0, 1, 2, or ≥3) after stratification by CAC score (0, 1-100, 101-300, and >300). The following traditional modifiable RFs were considered: cigarette smoking, LDL cholesterol ≥3.4 mmol/L, low HDL cholesterol, hypertension, and diabetes. There were 1067 subjects (16%) with 0 RFs, whereas 1205 (18%) had ≥3 RFs. Among individuals with 0 RFs, 68% had CAC 0, whereas 12 and 5% had CAC >100 and >300, respectively. Among individuals with ≥3 RFs, 35% had CAC 0, whereas 34 and 19% had CAC >100 and >300, respectively. Overall, 339 (5.1%) CHD events occurred. Individuals with 0 RFs and CAC >300 had an event rate 3.5 times higher than individuals with ≥3 RFs and CAC 0 (10.9/1000 vs. 3.1/1000 person-years). Similar results were seen across categories of Framingham risk score. Conclusion: Among individuals at the extremes of RF burden, the distribution of CAC is heterogeneous. The presence of a high CAC burden, even among individuals without RFs, is associated with an elevated event rate, whereas the absence of CAC, even among those with many RF, is associated with a low event rate. Coronary artery calcium has the potential to further risk stratify asymptomatic individuals at the extremes of RF burden.

Original languageEnglish (US)
Pages (from-to)2232-2241
Number of pages10
JournalEuropean Heart Journal
Volume35
Issue number33
DOIs
StatePublished - Sep 1 2014
Externally publishedYes

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Coronary Disease
Atherosclerosis
Coronary Vessels
Calcium
LDL Cholesterol
HDL Cholesterol
Smoking
Hypertension

Keywords

  • Coronary artery calcium
  • Coronary heart disease
  • Risk factors

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Impact of coronary artery calcium on coronary heart disease events in individuals at the extremes of traditional risk factor burden : The Multi-Ethnic Study of Atherosclerosis. / Silverman, Michael G.; Blaha, Michael J.; Krumholz, Harlan M.; Budoff, Matthew J.; Blankstein, Ron; Sibley, Christopher; Agatston, Arthur; Blumenthal, Roger S.; Nasir, Khurram.

In: European Heart Journal, Vol. 35, No. 33, 01.09.2014, p. 2232-2241.

Research output: Contribution to journalArticle

Silverman, MG, Blaha, MJ, Krumholz, HM, Budoff, MJ, Blankstein, R, Sibley, C, Agatston, A, Blumenthal, RS & Nasir, K 2014, 'Impact of coronary artery calcium on coronary heart disease events in individuals at the extremes of traditional risk factor burden: The Multi-Ethnic Study of Atherosclerosis', European Heart Journal, vol. 35, no. 33, pp. 2232-2241. https://doi.org/10.1093/eurheartj/eht508
Silverman, Michael G. ; Blaha, Michael J. ; Krumholz, Harlan M. ; Budoff, Matthew J. ; Blankstein, Ron ; Sibley, Christopher ; Agatston, Arthur ; Blumenthal, Roger S. ; Nasir, Khurram. / Impact of coronary artery calcium on coronary heart disease events in individuals at the extremes of traditional risk factor burden : The Multi-Ethnic Study of Atherosclerosis. In: European Heart Journal. 2014 ; Vol. 35, No. 33. pp. 2232-2241.
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abstract = "Aims: We sought to evaluate the impact of coronary artery calcium (CAC) in individuals at the extremes of risk factor (RF) burden. Methods and results: 6698 individuals from the Multi-Ethnic Study of Atherosclerosis (MESA) were followed for coronary heart disease (CHD) events over mean 7.1 ± 1 years. Annualized CHD event rates were compared among each RF category (0, 1, 2, or ≥3) after stratification by CAC score (0, 1-100, 101-300, and >300). The following traditional modifiable RFs were considered: cigarette smoking, LDL cholesterol ≥3.4 mmol/L, low HDL cholesterol, hypertension, and diabetes. There were 1067 subjects (16{\%}) with 0 RFs, whereas 1205 (18{\%}) had ≥3 RFs. Among individuals with 0 RFs, 68{\%} had CAC 0, whereas 12 and 5{\%} had CAC >100 and >300, respectively. Among individuals with ≥3 RFs, 35{\%} had CAC 0, whereas 34 and 19{\%} had CAC >100 and >300, respectively. Overall, 339 (5.1{\%}) CHD events occurred. Individuals with 0 RFs and CAC >300 had an event rate 3.5 times higher than individuals with ≥3 RFs and CAC 0 (10.9/1000 vs. 3.1/1000 person-years). Similar results were seen across categories of Framingham risk score. Conclusion: Among individuals at the extremes of RF burden, the distribution of CAC is heterogeneous. The presence of a high CAC burden, even among individuals without RFs, is associated with an elevated event rate, whereas the absence of CAC, even among those with many RF, is associated with a low event rate. Coronary artery calcium has the potential to further risk stratify asymptomatic individuals at the extremes of RF burden.",
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AU - Silverman, Michael G.

AU - Blaha, Michael J.

AU - Krumholz, Harlan M.

AU - Budoff, Matthew J.

AU - Blankstein, Ron

AU - Sibley, Christopher

AU - Agatston, Arthur

AU - Blumenthal, Roger S.

AU - Nasir, Khurram

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N2 - Aims: We sought to evaluate the impact of coronary artery calcium (CAC) in individuals at the extremes of risk factor (RF) burden. Methods and results: 6698 individuals from the Multi-Ethnic Study of Atherosclerosis (MESA) were followed for coronary heart disease (CHD) events over mean 7.1 ± 1 years. Annualized CHD event rates were compared among each RF category (0, 1, 2, or ≥3) after stratification by CAC score (0, 1-100, 101-300, and >300). The following traditional modifiable RFs were considered: cigarette smoking, LDL cholesterol ≥3.4 mmol/L, low HDL cholesterol, hypertension, and diabetes. There were 1067 subjects (16%) with 0 RFs, whereas 1205 (18%) had ≥3 RFs. Among individuals with 0 RFs, 68% had CAC 0, whereas 12 and 5% had CAC >100 and >300, respectively. Among individuals with ≥3 RFs, 35% had CAC 0, whereas 34 and 19% had CAC >100 and >300, respectively. Overall, 339 (5.1%) CHD events occurred. Individuals with 0 RFs and CAC >300 had an event rate 3.5 times higher than individuals with ≥3 RFs and CAC 0 (10.9/1000 vs. 3.1/1000 person-years). Similar results were seen across categories of Framingham risk score. Conclusion: Among individuals at the extremes of RF burden, the distribution of CAC is heterogeneous. The presence of a high CAC burden, even among individuals without RFs, is associated with an elevated event rate, whereas the absence of CAC, even among those with many RF, is associated with a low event rate. Coronary artery calcium has the potential to further risk stratify asymptomatic individuals at the extremes of RF burden.

AB - Aims: We sought to evaluate the impact of coronary artery calcium (CAC) in individuals at the extremes of risk factor (RF) burden. Methods and results: 6698 individuals from the Multi-Ethnic Study of Atherosclerosis (MESA) were followed for coronary heart disease (CHD) events over mean 7.1 ± 1 years. Annualized CHD event rates were compared among each RF category (0, 1, 2, or ≥3) after stratification by CAC score (0, 1-100, 101-300, and >300). The following traditional modifiable RFs were considered: cigarette smoking, LDL cholesterol ≥3.4 mmol/L, low HDL cholesterol, hypertension, and diabetes. There were 1067 subjects (16%) with 0 RFs, whereas 1205 (18%) had ≥3 RFs. Among individuals with 0 RFs, 68% had CAC 0, whereas 12 and 5% had CAC >100 and >300, respectively. Among individuals with ≥3 RFs, 35% had CAC 0, whereas 34 and 19% had CAC >100 and >300, respectively. Overall, 339 (5.1%) CHD events occurred. Individuals with 0 RFs and CAC >300 had an event rate 3.5 times higher than individuals with ≥3 RFs and CAC 0 (10.9/1000 vs. 3.1/1000 person-years). Similar results were seen across categories of Framingham risk score. Conclusion: Among individuals at the extremes of RF burden, the distribution of CAC is heterogeneous. The presence of a high CAC burden, even among individuals without RFs, is associated with an elevated event rate, whereas the absence of CAC, even among those with many RF, is associated with a low event rate. Coronary artery calcium has the potential to further risk stratify asymptomatic individuals at the extremes of RF burden.

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KW - Coronary heart disease

KW - Risk factors

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