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Author Notes:

Parag H. Joshi, MD MHS, Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, E5.730F, Dallas, Texas 75390-8830, Tel: 214-645-8000, Fax: 214-645-2480. Email: parag.joshi@utsouthwestern.edu

The authors thank the other investigators, the staff, and the participants of the MESA and DHS for their valuable contributions. A full list of participating MESA investigators and institutions can be found at http://www.mesa-nhlbi.org.

A.M. is supported by American Heart Association postdoctoral fellowship award 19POST34400057 and by Abraham J. & Phyllis Katz foundation. P.H.J. has received grant support from the American Heart Association, Novo Nordisk, Sanofi/Regeneron, GlaxoSmithKline, AstraZeneca, and Pfizer and personal fees from Bayer and Regeneron; equity interest in Global Genomics Group. Rest of the authors have no disclosures.


Research Funding:

The MESA study is supported by contracts HHSN268201500003I, N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168 and N01-HC-95169 from the NHLBI, and by grants UL1-TR-000040,UL1-TR-001079, and UL1-TR-001420 from National Center for Advancing Translational Sciences. The DHS was funded by the Donald W. Reynolds Foundation, Las Vegas, Nevada, and partially supported by the National Center for Advancing Translational Sciences of the NIH under award Number UL1TR001105.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Cardiac & Cardiovascular Systems
  • Radiology, Nuclear Medicine & Medical Imaging
  • Cardiovascular System & Cardiology
  • atherosclerosis
  • calcium
  • cardiovascular disease
  • coronary artery disease
  • risk
  • stroke

Predictive Value of Coronary Artery Calcium Score Categories for Coronary Events Versus Strokes: Impact of Sex and Race MESA and DHS

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Journal Title:



Volume 13, Number 8


, Pages E010153-E010153

Type of Work:

Article | Post-print: After Peer Review


Background: Coronary artery calcium (CAC) predicts atherosclerotic cardiovascular disease (ASCVD) events, inclusive of coronary heart disease (CHD) and stroke, and is a decision-making aid for primary prevention. The predictive value of CAC categories for CHD and stroke separately and across sex and race groups of an asymptomatic population is unclear. Methods: White, Black, and Hispanic participants of MESA (Multi-Ethnic Study of Atherosclerosis) and DHS (Dallas Heart Study) underwent CAC measurement at enrollment and were followed for incident ASCVD events. Ten-year CHD-to-stroke incidence ratios across CAC score categories 0, 1 to 99, and ≥100 were assessed. Associations of CAC with incident CHD and stroke events were evaluated using multivariable-adjusted Cox models and multiplicative interactions of CAC with sex/race were tested. Results: Among 7042 participants (mean age, 57 years, 54% women, 36% Black, 23% Hispanic, 49% CAC=0, 19% CAC ≥100), 574 incident ASCVD events (333 CHD and 241 stroke) were observed over 12.3-year follow-up. Ten-year CHD-to-stroke incidence ratio increased significantly across CAC categories in men, women, Whites, Blacks, and Hispanics (all P<0.001). High CAC burden (score ≥100) was independently associated with ASCVD and CHD risk in all groups and with stroke risk in the overall cohort and Blacks. No sex- or race-based CAC interactions for ASCVD, CHD, and stroke events were observed. Adding CAC to a traditional risk factor model improved risk discrimination and reclassification for CHD but not for stroke events. Conclusions: In 2 population-based cohorts of asymptomatic individuals, 10-year CHD-to-stroke incidence ratio was higher with increasing CAC score categories across sex and race groups, and CAC was consistently a better predictor of CHD than stroke. High CAC burden comparably associated with ASCVD risk across sex and race groups.
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