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A Semi-Automated and Reproducible Biological-Based Method to Quantify Calcium Deposition In Vitro
Published on: June 2, 2022
Coronary Artery Calcium Volume and Density: Potential Interactions and Overall Predictive Value: The Multi-Ethnic
Michael H Criqui1, Jessica B Knox1, Julie O Denenberg1
1Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California.
Insights
Coronary artery calcium (CAC) volume and density significantly predict cardiovascular disease (CVD) events. CAC density inversely correlates with risk, while CAC volume positively correlates, improving risk prediction beyond standard scores.
Area of Science:
- Cardiovascular imaging and risk prediction.
- Atherosclerosis and coronary heart disease research.
Background:
- Coronary artery calcium (CAC) volume and density are established markers for cardiovascular disease (CVD).
- Previous research indicates a positive association between CAC volume and CVD events, and an inverse association for CAC density.
Purpose of the Study:
- To investigate interactions between CAC volume, CAC density, and various risk factors including age, sex, ethnicity, atherosclerotic cardiovascular disease (ASCVD) risk score, diabetes, and renal function.
- To evaluate the improvement in CVD risk prediction and reclassification using different CAC scoring methods compared to the ASCVD risk score.
Main Methods:
- Analysis of 3,398 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) cohort with prevalent CAC but no clinical CVD at baseline.
- Follow-up for incident CVD events over a median of 11.0 years, utilizing multivariable Cox models and receiver-operating characteristic analyses.
Main Results:
- Increased CAC volume was associated with higher risks of coronary heart disease (CHD) and CVD events (73% and 61% increase per SD, respectively).
- Increased CAC density was associated with lower risks of CHD and CVD events (28% and 25% decrease per SD, respectively).
- Significant interactions were found between CAC volume and age/ASCVD score, and CAC density and ASCVD score, particularly in lower-risk groups.
Conclusions:
- The inverse association of CAC density with CVD events is robust across various risk factors.
- Incorporating CAC volume and density into the ASCVD risk score significantly enhances prediction and reclassification of CHD and CVD events.
Objectives:
This study sought to determine the possibility of interactions between coronary artery calcium (CAC) volume or CAC density with each other, and with age, sex, ethnicity, the new atherosclerotic cardiovascular disease (ASCVD) risk score, diabetes status, and renal function by estimated glomerular filtration rate, and, using differing CAC scores, to determine the improvement over the ASCVD risk score in risk prediction and reclassification.
Background:
In MESA (Multi-Ethnic Study of Atherosclerosis), CAC volume was positively and CAC density inversely associated with cardiovascular disease (CVD) events.
Methods:
A total of 3,398 MESA participants free of clinical CVD but with prevalent CAC at baseline were followed for incident CVD events.
Results:
During a median 11.0 years of follow-up, there were 390 CVD events, 264 of which were coronary heart disease (CHD). With each SD increase of ln CAC volume (1.62), risk of CHD increased 73% (p < 0.001) and risk of CVD increased 61% (p < 0.001). Conversely, each SD increase of CAC density (0.69) was associated with 28% lower risk of CHD (p < 0.001) and 25% lower risk of CVD (p < 0.001). CAC density was inversely associated with risk at all levels of CAC volume (i.e., no interaction was present). In multivariable Cox models, significant interactions were present for CAC volume with age and ASCVD risk score for both CHD and CVD, and CAC density with ASCVD risk score for CVD. Hazard ratios were generally stronger in the lower risk groups. Receiver-operating characteristic area under the curve and Net Reclassification Index analyses showed better prediction by CAC volume than by Agatston, and the addition of CAC density to CAC volume further significantly improved prediction.
Conclusions:
The inverse association between CAC density and incident CHD and CVD events is robust across strata of other CVD risk factors. Added to the ASCVD risk score, CAC volume and density provided the strongest prediction for CHD and CVD events, and the highest correct reclassification.
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