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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Associations of the PREVENT Score with coronary artery and thoracic aortic calcification among South Asian Americans
Eve M Manghis1, Rachel S Chang1, Feng Lin1
1Division of General Internal Medicine, Department of Medicine, University of California, 1545 Divisadero Street, San Francisco, CA 94143, USA.
Insights
In South Asian adults, both coronary artery calcification (CAC) and thoracic aortic calcification (TAC) increase with atherosclerotic cardiovascular disease (ASCVD) risk. TAC is higher than CAC in women with intermediate ASCVD risk.
Area of Science:
- Cardiology
- Radiology
- Public Health
Background:
- South Asian populations exhibit a high prevalence of atherosclerotic cardiovascular disease (ASCVD).
- Coronary artery calcification (CAC) aids in risk stratification for intermediate ASCVD risk.
- The utility of thoracic aortic calcification (TAC) in reclassifying ASCVD risk remains unclear.
Purpose of the Study:
- To investigate the association between traditional cardiovascular risk factors and both CAC and TAC.
- To examine the relationship between predicted 10-year ASCVD risk and CAC/TAC.
- To determine if TAC can help reclassify ASCVD risk in South Asian adults.
Main Methods:
- Cross-sectional analysis of the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study.
- ASCVD risk calculated using the PREVENT equation, categorized into <5%, 5-10%, and ≥10%.
- TAC and CAC scores categorized as 0, 1-99, and ≥100; associations analyzed using logistic regression and cubic spline functions.
Main Results:
- Of 960 participants, 59.4% had CAC, 53.8% had TAC, and 42.4% had both.
- Both CAC and TAC were associated with older age, male sex, hypertension, diabetes, higher LDL-cholesterol, and statin use.
- Higher predicted ASCVD risk correlated with higher TAC in women and higher CAC in men; TAC exceeded CAC in women with PREVENT scores ≥7%.
Conclusions:
- In South Asian adults, higher predicted ASCVD risk is linked to increased CAC and TAC.
- TAC burden is greater than CAC burden in women with intermediate ASCVD risk (PREVENT scores 5-10%).
- Further research is warranted to ascertain the predictive value of high TAC for clinical cardiovascular events.
Background:
South Asian populations have a high risk of atherosclerotic cardiovascular disease (ASCVD). Coronary artery calcification (CAC) can guide clinical decision making in patients with intermediate ASCVD risk. Thoracic aortic calcification (TAC) can be measured from the same computed tomography scan, though it is unknown whether TAC may help reclassify ASCVD risk.
Methods:
We conducted a cross-sectional analysis of the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study. Ten-year ASCVD risk was calculated using the American Heart Association Predicting Risk of cardiovascular disease Events equation (PREVENT), categorized as <5 %, 5 to <10 % or ≥10 %. TAC and CAC scores were categorized as 0, 1-99, and ≥100. We determined associations of traditional risk factors with TAC and CAC and used cubic spline functions to examine non-linear associations between PREVENT and TAC and CAC, overall and stratified by gender.
Results:
Of 960 participants, 59.4 % had any CAC, 53.8 % had any TAC, and 42.4 % had both CAC and TAC. Any TAC and any CAC were each more likely with older age, among men, and in those with hypertension, diabetes, higher LDL-cholesterol, and statin use. Higher PREVENT-ASCVD risk was associated with higher TAC in women and higher CAC in men. Among women, TAC was significantly higher than CAC in PREVENT scores ≥7 %.
Conclusion:
In South Asian US adults, higher PREVENT-ASCVD risk is associated with higher CAC and TAC. TAC burden is higher than CAC among women with PREVENT scores 5 to <10 %. Further studies should explore if high TAC is predictive of clinical events.
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