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Mediation of cardiovascular risk factor effects through subclinical vascular disease: the Multi-Ethnic Study of

Joseph Yeboah1, Joseph A Delaney2, Robin Nance2

  • 1From the Heart and Vascular Center of Excellence, Wake Forest University School of Medicine, Winston-Salem, NC (J.Y., D.M.H.); Department of Biostatistics, University of Washington, Seattle, WA (J.A.D., R.N., R.L.M.); Department of Radiology, Tufts Medical Center, Boston, MA (J.F.P.); National Institute of Health, Bethesda, MD (C.T.S.); Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC (A.B., G.L.B.); and Department of Radiology, Vanderbilt University School of Medicine, Nashville, TN (J.J.C.). jyeboah@wakehealth.edu.

Arteriosclerosis, Thrombosis, and Vascular Biology
|May 31, 2014
PubMed

Insights

Subclinical cardiovascular disease markers like coronary artery calcium (CAC) partially mediate risk factors

Area of Science:

  • Cardiovascular Medicine
  • Epidemiology
  • Biostatistics

Background:

  • Traditional cardiovascular risk factors are linked to incident cardiovascular disease (CVD) events.
  • The extent to which subclinical CVD markers mediate these associations is not fully understood.
  • Key subclinical markers include coronary artery calcium (CAC), carotid intima-media thickness (CIMT), and brachial flow-mediated dilation (FMD).

Purpose of the Study:

  • To quantify the mediating role of CAC, CIMT, and FMD in the relationship between traditional risk factors and incident CVD events.
  • To assess the proportion of risk factor effects on CVD outcomes that are transmitted through these subclinical CVD measures.

Main Methods:

  • Utilized data from 6,355 participants in the Multi-Ethnic Study of Atherosclerosis.
  • Employed nonlinear structural equation modeling to analyze mediation pathways.
  • Assessed mediation of traditional risk factors (age, sex, BMI, diabetes, smoking) on CVD events via CAC, CIMT, and FMD.

Main Results:

  • Coronary artery calcium (CAC) demonstrated the highest mediation effect, particularly for age.
  • Body mass index showed the most mediation through carotid intima-media thickness (CIMT).
  • Brachial flow-mediated dilation (FMD) exhibited the least mediation across all traditional risk factors.

Conclusions:

  • Subclinical CVD markers like CAC, CIMT, and FMD partially mediate the effects of many traditional risk factors on incident CVD.
  • The mediation levels suggest these markers may not be optimal for exclusively gauging upstream risk factor modification.
  • Age, sex, and BMI showed varying degrees of mediation, highlighting differential pathways in CVD development.
Abstract

Keywords:
cardiovascular eventscarotid intima-media thicknesscoronary artery calcium scoreflow-mediated dilationrisk factors

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