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Risk factor differences in calcified and noncalcified aortic plaque: the Framingham Heart Study
Michael L Chuang1, Philimon Gona1, Noriko Oyama-Manabe1
1From the National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (M.L.C., P.G., E.S.M., C.J.O.); Department of Quantitative Health Sciences, Division of Biostatistics and Health Services Research, University of Massachusetts Medical School, Worcester (P.G.); Departments of Medicine (Cardiovascular Division) (N.O.-M., C.J.S., W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Medicine, Division of Cardiology (C.J.O.) and The Cardiac MR PET CT Program, Department of Radiology (U.H.), Massachusetts General Hospital, Boston; and Harvard Medical School, Boston, MA (U.H., W.J.M., C.J.O.).
Objective:
The objective of this study was to determine the prevalence and risk factor (RF) correlates of aortic plaque (AP) detected by cardiovascular magnetic resonance (CMR), which mainly shows noncalcified plaques, and by noncontrast computed tomography (CT), which best depicts calcified plaques, in community-dwelling adults.
Approach And Results:
A total of 1016 Framingham Heart Study Offspring cohort members (64 ± 9 years; 474 men) underwent CMR and CT of the aorta. Potential RFs for AP (age; sex; body mass index; blood pressure; low-density lipoprotein and high-density lipoprotein cholesterol; fasting glucose; C-reactive protein; prevalent hypertension, diabetes mellitus, smoking; use of antihypertensive, diabetes mellitus, or lipid-lowering drugs) were compared between participants, with zero versus nonzero AP by CMR and by CT. Candidate RFs attaining P<0.05 for difference with either imaging modality were entered into multivariable logistic regression models adjusting for age, sex, and other RFs. Odds ratios were calculated for modality-specific prevalence of AP. Associations between RFs and continuous measures of AP were assessed using Tobit regression. Prevalence of CMR and CT AP was 49% and 82%, respectively. AP burdens by CMR and CT were correlated, r=0.28, P<0.0001. Increasing age and smoking were associated with prevalent AP by both CMR and CT. Additionally, prevalent AP by CMR was associated with female sex and fasting glucose and prevalent AP by CT with hypertension treatment and adverse lipid profile.
Conclusions:
AP by CMR and CT are both associated with smoking and increasing age, but other RFs differ between calcified and noncalcified AP. The relative predictive value of AP detected by CMR versus by CT for incident cardiovascular events remains to be determined.