Predictive Value of Coronary Artery Calcium Score Categories for Coronary Events Versus Strokes: Impact of Sex and Race

Year: 2020

Type: article

Abstract: Background: Coronary artery calcium (CAC) predicts atherosclerotic cardiovascular disease (ASCVD) events, inclusive of coronary heart disease (CHD) and stroke, and is a decision-making aid for primary prevention. The predictive value of CAC categories for CHD and stroke separately and across sex and race groups of an asymptomatic population is unclear. Methods: White, Black, and Hispanic participants of MESA (Multi-Ethnic Study of Atherosclerosis) and DHS (Dallas Heart Study) underwent CAC measurement at enrollment and were followed for incident ASCVD events. Ten-year CHD-to-stroke incidence ratios across CAC score categories 0, 1 to 99, and ≥100 were assessed. Associations of CAC with incident CHD and stroke events were evaluated using multivariable-adjusted Cox models and multiplicative interactions of CAC with sex/race were tested. Results: Among 7042 participants (mean age, 57 years, 54% women, 36% Black, 23% Hispanic, 49% CAC=0, 19% CAC ≥100), 574 incident ASCVD events (333 CHD and 241 stroke) were observed over 12.3-year follow-up. Ten-year CHD-to-stroke incidence ratio increased significantly across CAC categories in men, women, Whites, Blacks, and Hispanics (all P <0.001). High CAC burden (score ≥100) was independently associated with ASCVD and CHD risk in all groups and with stroke risk in the overall cohort and Blacks. No sex- or race-based CAC interactions for ASCVD, CHD, and stroke events were observed. Adding CAC to a traditional risk factor model improved risk discrimination and reclassification for CHD but not for stroke events. Conclusions: In 2 population-based cohorts of asymptomatic individuals, 10-year CHD-to-stroke incidence ratio was higher with increasing CAC score categories across sex and race groups, and CAC was consistently a better predictor of CHD than stroke. High CAC burden comparably associated with ASCVD risk across sex and race groups.

Source: Circulation Cardiovascular Imaging

DOI: 10.1161/circimaging.119.010153

Authors: Anurag Mehta, Ambarish Pandey, Colby R. Ayers, Amit Khera, Laurence S. Sperling, Moyses Szklo, Rebecca F. Gottesman, Mathew J. Budoff, Michael J. Blaha, Roger S. Blumenthal, Khurram Nasir, Parag H. Joshi

Institutions: Emory University, The University of Texas Southwestern Medical Center, Johns Hopkins University, Johns Hopkins Medicine, University of California, Los Angeles, The Lundquist Institute, Los Angeles Medical Center, Houston Methodist, Johns Hopkins Hospital

Language: English

Topic: Cardiac Imaging and Diagnostics

Subfield: Radiology, Nuclear Medicine and Imaging

Field: Medicine

Domain: Health Sciences

SDGs: Good health and well-being, Reduced inequalities

Open Access status: green

Funders: National Institutes of Health, National Heart, Lung, and Blood Institute, National Center for Advancing Translational Sciences

OpenAlex ID: W3076568904