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Interplay Between Social Vulnerability Index and Coronary Artery Calcium Scores With Major Adverse Cardiovascular
Zainab Albar1, Pedro R V O Salerno2, Nour Tashtish2,1
1Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH (Z.A., N.T., S.L., S.D., S.R.).
Insights
Social Vulnerability Index (SVI) impacts cardiovascular risk prediction from Coronary Artery Calcium (CAC) scores. Higher SVI independently predicts major adverse cardiovascular events (MACE), highlighting a need for targeted interventions.
Area of Science:
- Cardiology
- Public Health
- Health Disparities
Background:
- Coronary Artery Calcium (CAC) scoring is a key cardiovascular risk predictor.
- Social determinants of health, like the Social Vulnerability Index (SVI), may influence CAC's prognostic value.
- The interplay between SVI and CAC in predicting cardiovascular events requires investigation.
Purpose of the Study:
- To determine if the Social Vulnerability Index (SVI) modifies the association between Coronary Artery Calcium (CAC) scores and major adverse cardiovascular events (MACE).
- To assess the independent predictive value of SVI on cardiovascular outcomes within a community-based screening cohort.
Main Methods:
- Analysis of 49,224 participants undergoing CAC scanning (2014-2022) without prior cardiovascular disease.
- SVI determined by census tract; 8-year MACE incidence examined across CAC score strata and SVI quartiles.
- Cox proportional hazard models used to estimate MACE risk associated with demographics, metabolic factors, and CAC, adjusted for SVI.
Main Results:
- Higher SVI correlated with female sex, non-White race, increased comorbidities, and elevated CAC scores.
- An increasing SVI quartile was associated with a monotonic rise in 8-year MACE rates (HR 1.54 for highest vs. lowest SVI quartile).
- SVI significantly modified the CAC-MACE association, revealing a steeper risk gradient across CAC strata in socially vulnerable populations.
Conclusions:
- The Social Vulnerability Index (SVI) independently predicts adverse cardiovascular outcomes across all Coronary Artery Calcium (CAC) score levels.
- Social vulnerability exacerbates cardiovascular risk, necessitating focused interventions to mitigate its impact.
- Community-based screening data reveal critical health disparities influencing cardiovascular event prediction.
Background:
Coronary artery calcium (CAC) scoring predicts cardiovascular risk, but social determinants of health may play a role in its prognostic ability. We examined whether the Social Vulnerability Index (SVI) modifies the association between CAC and major adverse cardiovascular events (MACE) in a community-based screening cohort.
Methods:
We studied 49 224 participants without known cardiovascular disease referred for CAC scanning from 2014 to 2022 based on cardiovascular risk factors. SVI was determined for each participant based on the census tract. We examined 8-year incidence of MACE (myocardial infarction, stroke, heart failure, revascularization, death) by SVI quartile across CAC score strata (0, 1-99, 100-399, ≥400). Cox proportional hazard models estimated hazard ratios for MACE, associated with demographics, metabolic factors, and CAC.
Results:
Higher SVI was associated with female sex, non-White race, greater comorbidities, and higher CAC scores. The 8-year MACE rate increased monotonically by SVI quartile, with a hazard ratio of 1.54 (95% CI, 1.24-1.90, P<0.001) for the highest versus lowest SVI quartile after adjustment. The association between CAC score and MACE was modified by SVI, with a stronger gradient in risk across CAC strata apparent among vulnerable subgroups.
Conclusions:
In this no-cost community-based CAC cohort, SVI independently predicted adverse cardiovascular outcomes across all CAC strata. Focused efforts to mitigate the incremental risk associated with social vulnerability are needed.
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