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Association of cardiovascular disease risk factors with coronary artery calcium volume versus density
Isac C Thomas1,2, Brandon Shiau1, Julie O Denenberg1
1Division of Preventive Medicine, Department of Family Medicine and Public Health, University of California, San Diego, California, USA.
Insights
Cardiovascular disease risk factors have differing associations with coronary artery calcium (CAC) volume and density. Many risk factors inversely correlate with CAC density, suggesting complex relationships in atherosclerosis.
Area of Science:
- Cardiovascular Disease Research
- Atherosclerosis Imaging
- Biomarker Analysis
Background:
- Coronary artery calcium (CAC) density is linked to lower cardiovascular disease (CVD) event risk.
- The relationship between CVD risk factors and CAC volume versus density is not well understood.
Purpose of the Study:
- To investigate the associations of traditional CVD risk factors with both CAC volume and CAC density scores.
- To determine if risk factors for CAC volume and CAC density are similar or distinct.
Main Methods:
- Analysis of baseline data from 6814 participants in the Multi-Ethnic Study of Atherosclerosis (MESA).
- Inclusion of 3398 participants with detectable CAC.
- Application of multivariable linear regression models to assess independent associations.
Main Results:
- Most CVD risk factors were linked to higher CAC volume scores.
- Conversely, many risk factors, such as diabetes and certain race/ethnicities (Chinese, African-American, Hispanic), were associated with lower CAC density scores, even after accounting for CAC volume.
- For example, diabetes showed a higher CAC volume score but a lower CAC density score.
Conclusions:
- CVD risk factors exhibit differential associations with CAC volume and density in individuals without clinical CVD.
- A significant inverse association exists between several CVD risk factors and CAC density when controlling for CAC volume.
- These findings highlight the complex interplay between CVD risk factors and the distinct components of CAC.
Objectives:
Recently, the density score of coronary artery calcium (CAC) has been shown to be associated with a lower risk of cardiovascular disease (CVD) events at any level of CAC volume. Whether risk factors for CAC volume and CAC density are similar or distinct is unknown. We sought to evaluate the associations of CVD risk factors with CAC volume and CAC density scores.
Methods:
Baseline measurements from 6814 participants free of clinical CVD were collected for the Multi-Ethnic Study of Atherosclerosis. Participants with detectable CAC (n=3398) were evaluated for this study. Multivariable linear regression models were used to evaluate independent associations of CVD risk factors with CAC volume and CAC density scores.
Results:
Whereas most CVD risk factors were associated with higher CAC volume scores, many risk factors were associated with lower CAC density scores. For example, diabetes was associated with a higher natural logarithm (ln) transformed CAC volume score (standardised β=0.44 (95% CI 0.31 to 0.58) ln-units) but a lower CAC density score (β=-0.07 (-0.12 to -0.02) density units). Chinese, African-American and Hispanic race/ethnicity were each associated with lower ln CAC volume scores (β=-0.62 (-0.83to -0.41), -0.52 (-0.64 to -0.39) and -0.40 (-0.55 to -0.26) ln-units, respectively) and higher CAC density scores (β= 0.41 (0.34 to 0.47), 0.18 (0.12 to 0.23) and 0.21 (0.15 to 0.26) density units, respectively) relative to non-Hispanic White.
Conclusions:
In a cohort free of clinical CVD, CVD risk factors are differentially associated with CAC volume and density scores, with many CVD risk factors inversely associated with the CAC density score after controlling for the CAC volume score. These findings suggest complex associations between CVD risk factors and these components of CAC.
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