Related Experiment Video
Updated: Jun 6, 2025
Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Abdominal Compared With Coronary Artery Calcification and Incident Cardiovascular Events and Mortality in Black
Temidayo A Abe1, Fengxia Yan2,3,4, Titilope Olanipekun5
1Division of Cardiology, Department of Medicine (T.A.A.), Vanderbilt University Medical Center, Nashville, TN.
Insights
Abdominal aortic calcification (AAC) is as effective as coronary artery calcium (CAC) in predicting cardiovascular events for Black adults. AAC may offer valuable risk assessment when CAC scores are zero.
Area of Science:
- Cardiology
- Public Health
- Radiology
Background:
- Black adults face higher cardiovascular disease (CVD) risk, often underestimated by traditional coronary artery calcium (CAC) scores.
- Abdominal aortic calcification (AAC) precedes CAC and may better predict CVD events in Black adults prone to early atherosclerosis.
- Existing risk calculators may not fully capture CVD risk in this demographic.
Purpose of the Study:
- To evaluate the predictive value of abdominal aortic calcification (AAC) compared to coronary artery calcium (CAC) for cardiovascular events and mortality in Black adults.
- To assess the incremental value of AAC and CAC in risk stratification beyond the standard cardiovascular risk algorithm.
- To investigate the association of AAC with cardiovascular outcomes in individuals with a CAC score of zero.
Main Methods:
- Analysis of 2551 participants from the Jackson Heart Study (JHS) without pre-existing cardiovascular disease.
- Cox regression models were used to estimate hazard ratios for cardiovascular events and all-cause mortality.
- The predictive performance of CAC and AAC was assessed, both independently and when added to the pool cohort equation using net reclassification index.
Main Results:
- Over 12.6 years, higher CAC and AAC were associated with increased cardiovascular events and all-cause mortality.
- The incremental predictive value of CAC and AAC to the standard risk algorithm was comparable.
- Notably, 45% of participants with a CAC score of zero had detectable AAC, and AAC independently predicted cardiovascular events in this subgroup.
Conclusions:
- Abdominal aortic calcification (AAC) demonstrates comparable predictive value to coronary artery calcium (CAC) for cardiovascular events and mortality in Black adults.
- AAC serves as a valuable tool for cardiovascular risk assessment, particularly in individuals with a CAC score of zero.
- These findings highlight the importance of considering AAC in the comprehensive risk evaluation of Black adults.
Background:
Black adults show heightened cardiovascular risk compared with other groups despite comparable or lower coronary artery calcium (CAC) scores, indicating potential cardiovascular risk underestimation by CAC. Abdominal aortic calcification (AAC), preceding CAC, may predict cardiovascular events better in Black adults who are prone to early atherosclerotic cardiovascular disease and excess events at low CAC scores.
Methods:
We included 2551 participants from the JHS (Jackson Heart Study) visit 2 examination (2005-2008) without cardiovascular disease, followed through 2016. Cox regression estimated hazard ratios for incident cardiovascular events defined as a composite of myocardial infarction, stroke, heart failure, and all-cause mortality. The predictive value of CAC and AAC, when added to the American College of Cardiology/American Heart Association cardiovascular risk algorithm (pool cohort equation), was assessed.
Results:
Mean age was 57±10 years; 66% were women. Over a follow-up period of 12.6 years, 287 (11.3%) cardiovascular events and 360 (14.1%) mortality cases were observed. Adjusting for demographic and clinical variables, each 2-fold increase in CAC and AAC was associated with cardiovascular events (CAC: hazard ratio, 1.10 [95% CI, 1.06-1.13]; AAC: hazard ratio, 1.10 [95% CI, 1.06-1.13]) and all-cause mortality CAC: hazard ratio, 1.04 [95% CI, 1.01-1.08]; AAC: hazard ratio, 1.05 [95% CI, 1.01-1.08]). The incremental value of CAC (0.17 [95% CI, 0.08-0.23]) and AAC (0.15 [95% CI, 0.07-0.29]) to the pool cohort equation by net reclassification index was comparable. Notably, 45% of participants with 0 CAC showed some degree of AAC. Each 2-fold increase in AAC was associated with an increased risk of cardiovascular events (hazard ratio, 1.07 [95% CI, 1.01-1.19]) but not all-cause mortality among participants with 0 CAC.
Conclusions:
AAC is comparable to CAC in predicting cardiovascular events and all-cause mortality among Black adults, potentially valuable when CAC is absent.
Related Concept Videos
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:28Imaging Studies for Cardiovascular System V: CT
01:20Imaging Studies for Cardiovascular System III: X-Ray
Definition and Purpose
An X-ray, or radiograph, is a non-invasive method that uses ionizing radiation to take images of internal structures. It is mainly used in cardiac imaging to examine the heart, lungs, and major blood vessels, aiming to identify abnormalities in the heart's size, shape, and position, such as heart failure, congenital defects, and vascular...