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Published on: August 28, 2018
Coronary artery calcium and incident cerebrovascular events in an asymptomatic cohort. The MESA Study
Ashleigh O Gibson1, Michael J Blaha2, Martinson K Arnan3
1Heart and Vascular Center of Excellence, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
Insights
Coronary artery calcium (CAC) scoring predicts cerebrovascular events (CVE) in asymptomatic adults. Higher CAC scores indicate increased CVE risk, improving current risk assessment tools.
Area of Science:
- Cardiology
- Neurology
- Preventive Medicine
Background:
- Coronary artery calcium (CAC) score measures atherosclerotic burden and predicts coronary heart disease events.
- The predictive value of CAC for cerebrovascular events (CVE) remains unclear.
Purpose of the Study:
- To assess the predictive value of CAC score for CVE in an asymptomatic multiethnic cohort.
- To determine if CAC improves risk prediction beyond established factors.
Main Methods:
- Utilized data from 6,779 participants in the Multi-Ethnic Study of Atherosclerosis (MESA).
- Measured baseline CAC and followed participants for incident CVE (strokes or transient ischemic attacks) for an average of 9.5 years.
Main Results:
- A total of 234 (3.5%) CVE occurred during follow-up.
- CAC presence was associated with lower event-free survival (p < 0.0001).
- Log-transformed CAC independently predicted CVE (HR: 1.13, p < 0.0001) and improved risk discrimination (c-statistic 0.755 vs. 0.744).
Conclusions:
- CAC is an independent predictor of CVE in asymptomatic adults.
- CAC enhances the discriminative ability of current stroke risk scores, including the Framingham stroke risk score.
Objectives:
This study assessed the predictive value of coronary artery calcium (CAC) score for cerebrovascular events (CVE) in an asymptomatic multiethnic cohort.
Background:
The CAC score, a measure of atherosclerotic burden, has been shown to improve prediction of coronary heart disease events. However, the predictive value of CAC for CVE is unclear.
Methods:
CAC was measured at baseline examination of participants (N = 6,779) of MESA (Multi-Ethnic Study of Atherosclerosis) and then followed for an average of 9.5 ± 2.4 years for the diagnosis of incident CVE, defined as all strokes or transient ischemic attacks.
Results:
During the follow-up, 234 (3.5%) adjudicated CVE occurred. In Kaplan-Meier analysis, the presence of CAC was associated with a lower CVE event-free survival versus the absence of CAC (log-rank chi-square: 59.8, p < 0.0001). Log-transformed CAC was associated with increased risk for CVE after adjusting for age, sex, race/ethnicity, body mass index, systolic and diastolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, cigarette smoking status, blood pressure medication use, statin use, and interim atrial fibrillation (hazard ratio [HR]: 1.13 [95% confidence interval (CI): 1.07 to 1.20], p < 0.0001). The American College of Cardiology/American Heart Association-recommended CAC cutoff was also an independent predictor of CVE and strokes (HR: 1.70 [95% CI: 1.24 to 2.35], p = 0.001, and HR: 1.59 [95% CI: 1.11 to 2.27], p = 0.01, respectively). CAC was an independent predictor of CVE when analysis was stratified by sex or race/ethnicity and improved discrimination for CVE when added to the full model (c-statistic: 0.744 vs. 0.755). CAC also improved the discriminative ability of the Framingham stroke risk score for CVE.
Conclusions:
CAC is an independent predictor of CVE and improves the discrimination afforded by current stroke risk factors or the Framingham stroke risk score for incident CVE in an initially asymptomatic multiethnic adult cohort.
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