Author + information
- Received October 25, 2012
- Revision received December 10, 2012
- Accepted December 21, 2012
- Published online March 26, 2013.
- Matthew J. Budoff, MD⁎,
- Rebekah Young, PhD†,
- Victor A. Lopez, MS‡,
- Richard A. Kronmal, PhD†,
- Khurram Nasir, MD, MPH⁎,§∥,¶,#,
- Roger S. Blumenthal, MD§,
- Robert C. Detrano, MD, PhD‡,
- Diane E. Bild, MD, MPH⁎⁎,
- Alan D. Guerci, MD††,
- Kiang Liu, PhD‡‡,
- Steven Shea, MD§§,
- Moyses Szklo, MD∥∥,
- Wendy Post, MD§,
- Joao Lima, MD§,
- Alain Bertoni, MD, MPH¶¶ and
- Nathan D. Wong, PhD, MPH‡,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Nathan D. Wong, Heart Disease Prevention Program, Department of Medicine, Sprague Hall 112, University of California, Irvine, California 92697-4101
Objectives The study examined whether progression of coronary artery calcium (CAC) is a predictor of future coronary heart disease (CHD) events.
Background CAC predicts CHD events and serial measurement of CAC has been proposed to evaluate atherosclerosis progression.
Methods We studied 6,778 persons (52.8% female) aged 45 to 84 years from the MESA (Multi-Ethnic Study of Atherosclerosis) study. A total of 5,682 persons had baseline and follow-up CAC scans approximately 2.5 ± 0.8 years apart; multiple imputation was used to account for the remainder (n = 1,096) missing follow-up scans. Median follow-up duration from the baseline was 7.6 (max = 9.0) years. CAC change was assessed by absolute change between baseline and follow-up CAC. Cox proportional hazards regression providing hazard ratios (HRs) examined the relation of change in CAC with CHD events, adjusting for age, gender, ethnicity, baseline calcium score, and other risk factors.
Results A total of 343 and 206 hard CHD events occurred. The annual change in CAC averaged 24.9 ± 65.3 Agatston units. Among persons without CAC at baseline (n = 3,396), a 5-unit annual change in CAC was associated with an adjusted HR (95% Confidence Interval) of 1.4 (1.0 to 1.9) for total and 1.5 (1.1 to 2.1) for hard CHD. Among those with CAC >0 at baseline, HRs (per 100 unit annual change) were 1.2 (1.1 to 1.4) and 1.3 (1.1 to 1.5), respectively. Among participants with baseline CAC, those with annual progression of ≥300 units had adjusted HRs of 3.8 (1.5 to 9.6) for total and 6.3 (1.9 to 21.5) for hard CHD compared to those without progression.
Conclusions Progression of CAC is associated with an increased risk for future hard and total CHD events.
This research was supported by NHLBI contracts N01-HC-95159 through N01-HC-95169. Dr. Budoff is a consultant for General Electric. Dr. Wong is a consultant for Re-Engineering Healthcare, Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Paolo Raggi, MD, served as the Guest Editor for this article.
- Received October 25, 2012.
- Revision received December 10, 2012.
- Accepted December 21, 2012.
- American College of Cardiology Foundation