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Competing cardiovascular outcomes associated with subclinical atherosclerosis (from the Multi-Ethnic Study of

Chintan S Desai1, Hongyan Ning, Joseph Kang

  • 1Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.

The American Journal of Cardiology
|March 19, 2013
PubMed

Insights

Subclinical atherosclerosis, measured by coronary artery calcium (CAC) scores, increases the risk of cardiovascular disease (CVD) events and non-CVD death. Coronary heart disease is the most common first CVD event across all CAC levels.

Area of Science:

  • Cardiovascular Medicine
  • Epidemiology
  • Preventive Cardiology

Background:

  • Subclinical atherosclerosis, detected by coronary artery calcium (CAC) scoring, is a significant predictor of cardiovascular disease (CVD) and non-CVD mortality.
  • Understanding the competing risks of specific CVD events versus non-CVD death in relation to atherosclerosis burden is crucial for risk stratification.

Purpose of the Study:

  • To investigate the competing risks of specific cardiovascular disease (CVD) events and non-CVD death associated with varying levels of subclinical atherosclerosis.
  • To analyze the temporal sequence and relative likelihood of different adverse outcomes based on coronary artery calcium (CAC) scores.

Main Methods:

  • Utilized data from 3,095 men and 3,486 women (aged 45-84) in the Multi-Ethnic Study of Atherosclerosis (MESA) cohort.
  • Employed competing Cox models to assess cumulative incidences and hazard ratios for CVD events and non-CVD death across CAC score strata (0, 1-99, ≥100).
  • Compared risks of specific CVD events (e.g., coronary heart disease) against non-CVD death as the first occurring event.

Main Results:

  • In women, higher CAC scores (≥100) were associated with a significantly greater hazard ratio for any CVD event (3.07) compared to non-CVD death, versus CAC score 0 (1.40).
  • Coronary heart disease was consistently the most frequent first CVD event across all CAC burden levels in both sexes.
  • Women with CAC scores ≥100 had a 6.24-fold increased hazard ratio for coronary heart disease compared to those with CAC scores of 0.

Conclusions:

  • Coronary artery calcium (CAC) scoring effectively identifies individuals at increased risk for cardiovascular events, particularly coronary heart disease.
  • This study provides a novel competing risks framework for understanding the sequence of cardiovascular events and non-CVD death in relation to atherosclerosis.
  • Risk stratification based on CAC burden is essential for predicting the likelihood of specific cardiovascular outcomes and overall mortality.

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