Predictors of diffuse coronary artery calcium phenotype in adults aged ≥ 75: The Atherosclerosis Risk in Communities
Abhishek Gami1, Siyu Zou2, Zeina A Dardari3
1Division of Cardiovascular Medicine and Cardiovascular Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Insights
Long-term exposure to traditional cardiovascular disease risk factors like high blood pressure and cholesterol is linked to more widespread coronary artery calcium (CAC) patterns in older adults.
Area of Science:
- Cardiology
- Gerontology
- Public Health
Background:
- Coronary artery calcium (CAC) scoring, often using the Agatston score, is standard for cardiovascular disease (CVD) risk assessment.
- Emerging research explores CAC distribution patterns beyond the Agatston score, assessing overall vessel calcification.
- Understanding diffuse CAC patterns may offer new insights into CVD risk in aging populations.
Purpose of the Study:
- To investigate the association between 30-year exposure to traditional CVD risk factors and diffuse CAC patterns.
- To analyze CAC distribution beyond the Agatston score in older adults (≥75 years).
Main Methods:
- Utilized data from the Atherosclerosis Risk in Communities (ARIC) study, including participants free of prior CVD.
- Calculated time-weighted average exposure to traditional CVD risk factors over 30 years.
- Defined a CAC diffusivity index (1 - [CAC in most affected vessel/total CAC]) to quantify calcification distribution.
Main Results:
- In 2201 participants (mean age 80), increased exposure to systolic blood pressure (SBP), LDL-C, and smoking were associated with more diffuse CAC.
- Lower HDL-C and limited education also showed independent associations with diffuse CAC patterns.
- Male sex was also independently associated with more diffuse CAC.
Conclusions:
- Longitudinal exposure to traditional CVD risk factors, including elevated SBP, LDL-C, and smoking, correlates with diffuse CAC.
- Lower HDL-C levels and limited education are also linked to more widespread calcification patterns.
- These findings highlight the impact of sustained risk factor exposure on CAC distribution in older adults.
Introduction:
Coronary artery calcium (CAC) scoring is a commonly used tool for cardiovascular disease (CVD) risk assessment and is reported using the Agatston score. However, there has been increasing interest in measures of CAC beyond the Agatston score, including measures capturing the overall distribution of vessel calcification. We assessed the association between 30-year traditional risk factor exposure and the presence of a more diffuse pattern of CAC in older adults aged 75 and older.
Methods:
We studied participants in the Atherosclerosis Risk in Communities (ARIC) study who underwent CAC scoring and were free of prior CVD. Time-weighted average exposure to traditional cardiovascular risk factors (over 30 years) was calculated. The CAC diffusivity index was calculated for each participant as 1 - (CAC in most affected vessel/total CAC) to capture distribution of calcification, and associations between traditional risk factors and more diffuse CAC patterns were studied.
Results:
In 2201 participants (mean age 80, 61.8% women), time-averaged exposure to systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), ever smoking, male sex, and limited education were independently associated with more diffuse CAC (p < 0.05).
Conclusion:
Longitudinal exposure to traditional CVD risk factors including higher SBP, higher LDL-C, lower HDL-C, and smoking was associated with a more diffuse pattern of CAC in a population of adults aged 75 and older.
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