Thoracic Aortic Calcium for the Prediction of Stroke Mortality (from the Coronary Artery Calcium Consortium)

Area of Science:

• Cardiovascular disease research
• Atherosclerosis imaging
• Stroke risk stratification

Background:

• Thoracic aortic calcium (TAC) is a marker of extracoronary atherosclerosis and predicts all-cause mortality.
• Coronary artery calcium (CAC) is an established cardiovascular risk score.
• The predictive value of TAC for stroke mortality, independent of CAC, requires further investigation.

Purpose of the Study:

• To determine if thoracic aortic calcium (TAC) predicts stroke mortality independently of coronary artery calcium (CAC) score.
• To assess the association between TAC and stroke mortality after adjusting for traditional cardiovascular risk factors.
• To explore potential sex differences in the association between TAC and stroke mortality.

Main Methods:

• Utilized the CAC Consortium database (66,636 patients, aged ≥18, no prior cardiovascular disease).
• Assessed TAC from baseline CAC scans in 41,066 patients, analyzed as present or absent.
• Employed multivariable-adjusted Fine and Gray competing risk regression models, accounting for traditional risk factors and CAC score.

Main Results:

• The presence of TAC was associated with a significantly higher risk of stroke mortality (unadjusted SHR: 8.80; adjusted SHR: 2.21).
• After adjustment for traditional risk factors and CAC score, TAC remained an independent predictor of stroke mortality.
• The association between TAC and stroke mortality was more pronounced in women (fully adjusted SHR: 3.42) compared to men (fully adjusted SHR: 1.55).

Conclusions:

• Thoracic aortic calcium (TAC) is an independent risk marker for stroke mortality.
• TAC provides incremental predictive value for stroke mortality beyond CAC and traditional risk factors.
• The findings suggest that TAC may be particularly important for stroke risk assessment in women.