Journal
EUROPEAN HEART JOURNAL
Volume 35, Issue 33, Pages 2232-2241Publisher
OXFORD UNIV PRESS
DOI: 10.1093/eurheartj/eht508
Keywords
Coronary artery calcium; Risk factors; Coronary heart disease
Categories
Funding
- National Institutes of Health [N01-HC-95159, N01-HC-95166, N01-HC-95169, U01HL105270-03, T32-HL-7227-36]
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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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