Comparison of Carotid Plaque Score and Coronary Artery Calcium Score for Predicting Cardiovascular Disease Events: The Multi‐Ethnic Study of Atherosclerosis

Gepner, Adam D.; Young, Rebekah; Delaney, Joseph A.; Budoff, Matthew J.; Polak, Joseph F.; Blaha, Michael J.; Post, Wendy S.; Michos, Erin D.; Kaufman, Joel D.; Stein, James H.

doi:10.1161/jaha.116.005179

Cited by 135 publications

(94 citation statements)

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“…3 CAC has already been shown to be a stronger predictor of CHD than stroke. 4,5 The fact that more patients have CT scans with thoracic ECC than CAC, make thoracic ECC scoring a valuable method to be studied and utilized for patient risk assessment. Although CAC=0 is deemed to predict lower CVD risk 26 , Wong et al showed that more than 55% of MESA participants had extra-coronary calcification that may put them at high risk for CVD events.…”

Section: Discussionmentioning

confidence: 99%

“…2 The 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines placed an emphasis on the prediction of both CHD and stroke events. 3 However, CAC is a stronger predictor of CHD 2 than stroke 4, 5 . Therefore, further risk information, in particular other imaging data, may be needed beyond CAC to enhance prediction of stroke.…”

Section: Introductionmentioning

confidence: 99%

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Thoracic extra-coronary calcification for the prediction of stroke: The Multi-Ethnic Study of Atherosclerosis

et al. 2017

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Background and aims Atherosclerosis is a systemic disease. We examined whether the cumulative burden of thoracic extra-coronary calcification (ECC) improves prediction of stroke, transient ischemic attack (TIA), and stroke mortality beyond traditional risk factors and coronary artery calcium (CAC). Methods We followed a total of 6,805 participants (mean age 62.1±10.2 years, 47.2% male) from the Multi-Ethnic Study of Atherosclerosis (MESA) over a median of 12.1 years. The presence or absence of calcification at 4 thoracic ECC sites (mitral valve annulus, aortic valve, aortic root, and thoracic aorta) was determined from baseline cardiac-gated non-contrast CT scans. A multisite thoracic ECC score, ranging 0–4, was calculated by summing the 4 individual sites, which were treated as binary variables. Multivariable Cox proportional hazards regression models, controlled for traditional risk factors and CAC, were used to estimate hazard ratios for ischemic (primary endpoint) and hemorrhagic stroke, total stroke, TIA, and stroke mortality with increasing thoracic ECC. Results With an increasing number of thoracic ECC sites, there was a significant (p<0.05) multivariable adjusted step-wise increase in the risk for ischemic stroke (n=184), total stroke (n=235), and TIA (n=85), but not hemorrhagic stroke (n=32) and stroke mortality (n=42). Thoracic ECC increased the c-statistic and net reclassification index beyond traditional risk factors and CAC, but the results were not significant (p>0.10). Conclusions Although multisite thoracic ECC is independently associated with ischemic stroke, total stroke, and TIA, the incremental predictive value of thoracic ECC beyond traditional risk factors and CAC appears to be minimal.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Thoracic extra-coronary calcification for the prediction of stroke: The Multi-Ethnic Study of Atherosclerosis

et al. 2017

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“…Reread examination 1 IMT and plaque measurements were used in our analyses to ensure consistency with examination 5 measures; they also were more reproducible and plaque assessments were more concordant with clinical consensus recommendations than original measurements. Details of ultrasound IMT and plaque rereadings have been described previously . The small number of participants with ultrasound data at only examination 5 (N=5) were excluded from IMT and plaque analyses.…”

Section: Methodsmentioning

confidence: 99%

“…Carotid plaque presence was defined as a discrete focal wall thickening ≥1.5 mm or focal wall thickening ≥50% of the surrounding IMT . A carotid plaque score was used in our main analyses and calculated as the total number of plaques in the internal, bifurcation, and common carotid artery segments (range, 0–12) . Carotid plaque scores were available for 4319 participants with apolipoprotein measurements at baseline and 2753 participants at examination 5.…”

Section: Methodsmentioning

confidence: 99%

High‐Density Lipoprotein Subspecies Defined by Apolipoprotein C‐III and Subclinical Atherosclerosis Measures: MESA (The Multi‐Ethnic Study of Atherosclerosis)

Aroner

Koch

Mukamal

et al. 2018

JAHA

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BackgroundApolipoprotein C‐III (apoC‐III), a small proinflammatory protein present on 6% to 7% of high‐density lipoprotein (HDL) particles, defines a subspecies of HDL adversely associated with coronary heart disease in primarily white cohorts. In a multi‐ethnic population free of clinical cardiovascular disease, we evaluated the relationship between apoC‐III–defined HDL subspecies and subclinical markers of atherosclerotic pathology.Methods and ResultsWe investigated cross‐sectional associations between apolipoprotein A‐I concentrations of apoC‐III–defined HDL subspecies, measured via ELISA and imaging measures of subclinical atherosclerosis, among 4659 participants in the MESA (The Multi‐Ethnic Study of Atherosclerosis) at baseline (2000–2002). HDL particles containing and lacking apoC‐III were divergently associated with coronary artery calcification in women (P‐heterogeneity=0.002) but not in men (P‐heterogeneity=0.31) and with carotid plaque score (P‐heterogeneity=0.02) and intima‐media thickness (P‐heterogeneity=0.06) in the overall study population. HDL lacking apoC‐III was inversely associated with all outcome measures (coronary artery calcification, women: odds ratio per SD=0.81 [95% confidence interval [CI], 0.73–0.90]; carotid plaque, overall: odds ratio per SD=0.92 [95% CI, 0.84–1.00]; intima‐media thickness, overall: mean difference per SD=−14.0 µm [95% CI, −21.1 to −6.7 μm]), whereas HDL containing apoC‐III was positively associated (coronary artery calcification, women: odds ratio=1.10 [95% CI, 0.99–1.22]; plaque, overall: odds ratio=1.10 [95% CI, 1.01–1.19]) or unassociated. Neither total HDL nor HDL subspecies was associated with changes in subclinical atherosclerosis measures up to 10 years later.ConclusionsThe presence of apoC‐III defined a subspecies of HDL not inversely associated with baseline measures of subclinical atherosclerosis, supporting a role of apoC‐III in the pathophysiology of cardiovascular disease.

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“…For example, Cao and colleagues showed that the presence of intermediate and high-risk carotid plaque on carotid ultrasound conferred approximately a 2-fold increased risk of CVD event after adjustment for traditional CVD risk factors in the Cardiovascular Health Study, a study of adults (≥ 65 years) without known CVD 10 . In the younger Multi-Ethnic Study of Atherosclerosis (MESA) cohort study, carotid plaque score was also a significant predictor of CVD events after adjustment for traditional risk factors (HR 1.27, 95% CI 1.16–1.40, p< 0.001) 11 . The observed link between asymptomatic carotid plaque and subsequent CVD events in a cohort of persons living with HIV supports the potential utility of carotid plaque measurements as a biomarker of CVD risk stratification and CVD risk reduction.…”

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confidence: 99%

Imaging to End Points

Gharib

Hadigan

2017

Circ: Cardiovascular Imaging

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Comparison of Carotid Plaque Score and Coronary Artery Calcium Score for Predicting Cardiovascular Disease Events: The Multi‐Ethnic Study of Atherosclerosis

Abstract: Background--Coronary artery calcium (CAC) predicts coronary heart disease (CHD) events better than carotid wall plaque presence; however, differences in the utility of CAC burden and carotid plaque burden across the spectrum of cardiovascular disease (CVD) events is unknown.

Cited by 135 publications

References 30 publications

Thoracic extra-coronary calcification for the prediction of stroke: The Multi-Ethnic Study of Atherosclerosis

Thoracic extra-coronary calcification for the prediction of stroke: The Multi-Ethnic Study of Atherosclerosis

High‐Density Lipoprotein Subspecies Defined by Apolipoprotein C‐III and Subclinical Atherosclerosis Measures: MESA (The Multi‐Ethnic Study of Atherosclerosis)

Imaging to End Points

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