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Risk Factors for the Development and Progression of Thoracic Aorta Calcification: The Multi-Ethnic Study of
George Youssef1, Mengye Guo2, Robyn L McClelland2
1Department of Medicine, LA Biomedical Research Institute at Harbor, UCLA, 1124 West Carson St, Torrance, CA 90502.
Insights
Thoracic aortic calcification (TAC) incidence and progression are linked to traditional cardiovascular disease risk factors in a large multiethnic cohort. Black individuals exhibited lower TAC incidence and progression rates compared to other ethnic groups.
Area of Science:
- Cardiovascular disease research
- Medical imaging analysis
- Public health and epidemiology
Background:
- Vascular calcification, including thoracic aortic calcification (TAC), is a significant predictor of cardiovascular disease (CVD).
- Computed tomography (CT) is a key imaging modality for assessing coronary and thoracic aortic calcification.
- Prior studies on TAC progression were primarily in specific patient groups, such as those on dialysis or post-renal transplant.
Purpose of the Study:
- To investigate the incidence and progression of thoracic aortic calcification (TAC) in a large, multiethnic cohort without pre-existing clinically evident CVD.
- To identify traditional cardiovascular risk factors associated with TAC development and progression.
- To examine ethnic variations in TAC incidence and progression.
Main Methods:
- Utilized non-contrast-enhanced cardiac CT scans from 5886 participants in the Multi-Ethnic Study of Atherosclerosis (MESA) cohort.
- Calculated baseline and follow-up TAC scores using Agatston units.
- Analyzed incidence and progression rates over a mean follow-up of 2.4 years, adjusting for relevant covariates.
Main Results:
- 73% of participants had no detectable baseline TAC; 12% developed TAC during follow-up at an incidence rate of 4.8%/year.
- TAC incidence increased with age and was significantly lower in Black individuals compared to White individuals.
- Age, systolic blood pressure, antihypertensive use, and smoking were associated with incident TAC; age, systolic blood pressure, lipid-lowering medication, diabetes, and smoking were associated with TAC progression.
Conclusions:
- Traditional cardiovascular risk factors are associated with both the incidence and progression of thoracic aortic calcification (TAC).
- Black participants demonstrated the lowest rates of TAC incidence and progression, aligning with findings for coronary calcification.
- These findings highlight the role of traditional risk factors and ethnic differences in TAC development within a general population.
Rationale And Objectives:
Vascular calcification independently predicts cardiovascular disease (CVD), and computed tomography (CT) is a useful tool to evaluate and quantify not only coronary but also thoracic aortic calcification (TAC). Previous TAC progression reports were limited to dialysis and renal transplant patients. This is the first study to evaluate TAC progression in a large multiethnic cohort without clinically evident CVD at entry.
Methods:
Non-contrast-enhanced cardiac CTs were obtained in 5886 of 6814 Multi-Ethnic Study of Atherosclerosis (MESA) participants (mean age, 62 years; 48% males; 40% white, 27% black, 21% Hispanic, and 12% Chinese). Baseline and follow-up TAC scores were derived.
Results:
Overall, 4308 (73%) participants had no detectable baseline TAC. Mean follow-up duration was 2.4 ± 0.8 years, during which 12% developed TAC. The overall incidence rate was 4.8%/year and was greater with age across gender and ethnic groups; TAC incidence was significantly lower in blacks than whites. After adjustment for follow-up duration, regression analyses showed age, systolic blood pressure, antihypertensives, and smoking were associated with incident TAC. A total of 1578 (27%) participants had TAC at baseline with a positive association between average annual TAC change and baseline age. Although the overall median change was 32.9 (-1.4 to 112.2) Agatston units, 27% showed an annual score change of ≥100 and blacks showed the lowest median across ethnic groups; 22.7 (-3 to 86.8). Age, systolic blood pressure, lipid-lowering medication, diabetes, and smoking were associated with TAC progression.
Conclusions:
In MESA, traditional CV risk factors were related to both TAC incidence and progression. Blacks had the lowest incidence and median change across ethnic groups, consistent with previous findings for coronary calcification.
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