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Published on: August 28, 2018
Thoracic Aortic Calcium Density and Area in Long-Term Atherosclerotic Cardiovascular Disease Risk Among Men Versus
Alexander C Razavi1,2, Cherry Kim2,3, Marly van Assen2
1Emory Clinical Cardiovascular Research Institute (A.C.R., A.A.Q., V.V., L.S.S.), Emory University School of Medicine, Atlanta, GA.
Insights
Thoracic aortic calcium (TAC) density and area may indicate sex-specific atherosclerotic cardiovascular disease (ASCVD) risks. Low TAC density relative to area may signal increased ASCVD risk in women.
Area of Science:
- Cardiovascular Imaging
- Atherosclerosis Research
- Medical Diagnostics
Background:
- Thoracic aortic calcium (TAC) development precedes coronary artery calcium (CAC) more frequently in women than men.
- The role of TAC density and area in sex-specific atherosclerotic cardiovascular disease (ASCVD) risk remains unclear.
Purpose of the Study:
- To investigate sex-specific differences in TAC density and area.
- To determine if TAC density and area predict ASCVD mortality differently in men and women.
Main Methods:
- Analysis of 5317 primary prevention patients undergoing coronary artery calcium scoring.
- Comparison of TAC Agatston score, density, and area between men and women.
- Cox regression and multinomial logistic regression to assess associations with ASCVD mortality and risk factors.
Main Results:
- Women exhibited higher median TAC scores, density, and area than men.
- A stepwise increase in ASCVD mortality was observed with increasing TAC density-area groups in men.
- In women, low TAC density relative to area was associated with survival comparable to high-density-high-area groups.
- Low TAC density/high TAC area significantly increased ASCVD mortality risk in women (aHR 3.75) but not men (aHR 1.16).
- Risk factors for low TAC density/high TAC area differed by sex: diabetes in women, hypertension in men.
Conclusions:
- TAC density-area phenotypes do not consistently predict ASCVD mortality across sexes.
- Low TAC density relative to TAC area may serve as a specific marker for elevated ASCVD risk in women.
Background:
The development of thoracic aortic calcium (TAC) temporally precedes coronary artery calcium more often in women versus men. Whether TAC density and area confer sex-specific differences in atherosclerotic cardiovascular disease (ASCVD) risk is unknown.
Methods:
We studied 5317 primary prevention patients who underwent coronary artery calcium scoring on noncontrast cardiac gated computed tomography with TAC >0. The Agatston TAC score (Agatston units), density (Hounsfield units), and area (mm2) were compared between men and women. Cox proportional hazards regression calculated adjusted hazard ratios for TAC density-area groups with ASCVD mortality, adjusting for traditional risk factors, coronary artery calcium, and TAC. Multinomial logistic regression calculated adjusted odds ratios for the association between traditional risk factors and TAC density-area groups.
Results:
The mean age was 60.7 years, 38% were women, and 163 ASCVD deaths occurred over a median of 11.7-year follow-up. Women had higher median TAC scores (97 versus 84 Agatston units; P=0.004), density (223 versus 210 Hounsfield units; P<0.001), and area (37 versus 32 mm2; P=0.006) compared with men. There was a stepwise higher incidence of ASCVD deaths across increasing TAC density-area groups in men though women with low TAC density relative to TAC area (3.6 per 1000 person-years) had survival probability commensurate with the high-density-high-area group (4.8 per 1000 person-years). Compared with low TAC density-area, low TAC density/high TAC area conferred a 3.75-fold higher risk of ASCVD mortality in women (adjusted hazard ratio, 3.75 [95% CI, 1.13-12.44]) but not in men (adjusted hazard ratio, 1.16 [95% CI, 0.48-2.84]). Risk factors most strongly associated with low TAC density/high TAC area differed in women (diabetes: adjusted odds ratio, 2.61 [95% CI, 1.34-5.07]) versus men (hypertension: adjusted odds ratio, 1.45 [95% CI, 1.11-1.90]).
Conclusions:
TAC density-area phenotypes do not consistently associate with ASCVD mortality though low TAC density relative to area may be a marker of increased ASCVD risk in women.
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