Greater Volume but not Higher Density of Abdominal Aortic Calcium Is Associated With Increased Cardiovascular Disease Risk: MESA (Multi-Ethnic Study of Atherosclerosis)

Circ Cardiovasc Imaging. 2016 Nov;9(11):e005138. doi: 10.1161/CIRCIMAGING.116.005138.

Abstract

Background: Abdominal aortic calcium (AAC) and coronary artery calcium (CAC) independently and similarly predict cardiovascular disease (CVD) events. The standard AAC and CAC score, the Agatston method, upweights for greater calcium density, thereby modeling higher calcium density as a CVD hazard.

Methods and results: Computed tomography scans were used to measure AAC and CAC volume and density in a multiethnic cohort of community-dwelling individuals, and Cox proportional hazard was used to determine their independent association with incident coronary heart disease (CHD, defined as myocardial infarction, resuscitated cardiac arrest, or CHD death), cardiovascular disease (CVD, defined as CHD plus stroke and stroke death), and all-cause mortality. In 997 participants with Agatston AAC and CAC scores >0, the mean age was 66±9 years, and 58% were men. During an average follow-up of 9 years, there were 77 CHD, 118 CVD, and 169 all-cause mortality events. In mutually adjusted models, additionally adjusted for CVD risk factors, an increase in ln(AAC volume) per standard deviation was significantly associated with increased all-cause mortality (hazard ratio=1.20; 95% confidence interval, 1.08-1.33; P<0.01) and an increased ln(CAC volume) per standard deviation was significantly associated with CHD (hazard ratio=1.17; 95% confidence interval, 1.04-1.59; P=0.02) and CVD (hazard ratio=1.20; 95% confidence interval, 1.05-1.36; P<0.01). In contrast, both AAC and CAC density were not significantly associated with CVD events.

Conclusions: The Agatston method of upweighting calcium scores for greater density may be inappropriate for CVD risk prediction in both the abdominal aorta and coronary arteries.

Keywords: abdominal aorta; atherosclerosis; cardiovascular disease; computed tomography; coronary arteries; coronary heart disease.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aorta, Abdominal / diagnostic imaging*
  • Aortic Diseases / diagnostic imaging*
  • Aortic Diseases / ethnology
  • Aortic Diseases / mortality
  • Aortography / methods*
  • Atherosclerosis / diagnostic imaging*
  • Atherosclerosis / ethnology
  • Atherosclerosis / mortality
  • Computed Tomography Angiography*
  • Coronary Angiography / methods*
  • Coronary Artery Disease / diagnostic imaging*
  • Coronary Artery Disease / ethnology
  • Coronary Artery Disease / mortality
  • Coronary Vessels / diagnostic imaging*
  • Female
  • Heart Arrest / ethnology
  • Heart Arrest / mortality
  • Heart Arrest / therapy
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Multidetector Computed Tomography*
  • Multivariate Analysis
  • Myocardial Infarction / ethnology
  • Myocardial Infarction / mortality
  • Predictive Value of Tests
  • Proportional Hazards Models
  • Prospective Studies
  • Radiographic Image Interpretation, Computer-Assisted
  • Resuscitation
  • Risk Factors
  • Stroke / ethnology
  • Stroke / mortality
  • Time Factors
  • United States / epidemiology
  • Vascular Calcification / diagnostic imaging*
  • Vascular Calcification / ethnology
  • Vascular Calcification / mortality