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

• Authors: Anurag Mehta, Emory University; Ambarish Pandey, University of Texas Southwestern Medical Center; Colby R Ayers, University of Texas Southwestern Medical Center; Amit Khera, University of Texas Southwestern Medical Center; Laurence Sperling, Emory University; Moyses S Szklo, Johns Hopkins Bloomberg School of Public Health; Rebecca F Gottesman, Johns Hopkins University; Mathew J Budoff, University of California Los Angeles; Michael J Blaha, Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease; Roger S Blumenthal, Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease,; Khurram Nasir, Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease; Parag H Joshi, University of Texas Southwestern Medical Center
• Journal Title: CIRCULATION-CARDIOVASCULAR IMAGING
• Volume: Volume 13, Number 8
• Publisher: LIPPINCOTT WILLIAMS & WILKINS | 2020-08-01, Pages E010153-E010153
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1161/CIRCIMAGING.119.010153
• Subjects: Health Sciences, Oncology
• Keywords: 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; RISK CLASSIFICATION; ATHEROSCLEROSIS; CALCIFICATION

Abstract

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.