Comparison of Coronary Artery Calcium Presence, Carotid Plaque Presence, and Carotid Intima-Media Thickness for Cardiovascular Disease Prediction in the Multi-Ethnic Study of Atherosclerosis

Abstract

Background Presence of coronary artery calcium (CAC), carotid plaque, and increased carotid intima media thickness (IMT) may indicate elevated cardiovascular disease (CVD) risk; however, no large studies have compared them directly. This study compares predictive utilities of CAC presence, carotid artery plaque presence, and high IMT for incident CVD events. Methods and Results Participants were from the Multi-Ethnic Study of Atherosclerosis. Predictive values of carotid plaque, IMT and CAC presence were compared using Cox proportional hazards models, c-statistics, and net reclassification indices. The 6,779 participants were mean (standard deviation) 62.2 (10.2) years old; 49.9% had CAC, 46.7% had carotid plaque. The mean left and right IMT were 0.754 (0.210) mm and 0.751 (0.187) mm, respectively. After 9.5 years (mean), 538 CVD events, 388 coronary heart disease (CHD) events, and 196 stroke/transient ischemic attacks (TIA) were observed. CAC presence was a stronger predictor of incident CVD and CHD than carotid ultrasound measures. Mean IMT ≥75th percentile (for age, sex and race) alone did not predict events. Compared to traditional risk factors, c-statistics for CVD (c=0.756) and CHD (c=0.752) increased most by adding of CAC presence (CVD 0.776, CHD, 0.784; p<0.001) followed by carotid plaque presence (CVD c=0.760, CHD 0.757; p<0.05). Compared to risk factors (c=0.782), carotid plaque presence (c=0.787, p=0.045) but not CAC (c=0.785, p=0.438) improved prediction of stroke/TIA. Conclusions In adults without CVD, CAC presence improves prediction of CVD and CHD more than carotid plaque presence or high IMT. CAC and carotid ultrasound parameters performed similarly for stroke/TIA event prediction.

Cardiovascular Disease Imaging in HIV

“…7 Recent data using novel macrophage-specific imaging agents extend our knowledge of the basis of this disease and suggest significant macrophage infiltration in the vascular system. 10 ] These data expand a growing body of literature describing the unique nature of CVD and using advanced cardiovascular imaging to help us to extend our understanding of the disease. Similar to the study of Phan et al, 9 other studies using coronary computed tomography angiography have demonstrated an increased presence and extent of coronary artery disease, including noncalcified coronary plaque 11,12 and high-risk coronary plaque features, such as low attenuation and positive remodeling, accompanied by increased indices of immune activation.…”

The Risk Factors and Evaluation Criteria for Progression of Atherosclerosis in One Year Post Coronary Bypass

“…Отдельные работы, имеющие целью оценку проявлений периферического атеросклероза, изучают прогрессирование по изменению лодыжечно-плече-вого индекса (ЛПИ). Большинство исследований включают пациентов либо исходно здоровых, либо имеющих определенную патологию (СД, ХБП), но без сердечно-сосудистых заболеваний (ССЗ) [1][2][3].…”

“…Однако, в исследовании MESA [1], после исклю-чения из анализа пациентов с СД значение КИМ как в целом, так и выше 75 перцентиля не являлось пре-диктором сердечно-сосудистых событий. Наиболее значимым предиктором был коронарный кальций, оцененный при МСКТ (ОР 3,12, 95% ДИ 2,44-3,99, p<0,001).…”

“…Наиболее значимым предиктором был коронарный кальций, оцененный при МСКТ (ОР 3,12, 95% ДИ 2,44-3,99, p<0,001). Кроме того, риск возникновения сосудис-тых катастроф предсказывало наличие атеросклеро-тической бляшки в сонных артериях (ОР 1,61, 95% ДИ 1,17-2,21, p=0,003) [1]. Таким образом, значи-мость толщины КИМ в качестве прогностического инструмента подвергнута сомнению, поскольку низ-кая предсказательная ценность экстраполирована с пациентов с СД на лиц без нарушений углеводного обмена.…”

Status of lung cancer screening

“…These thoracic cavity confined comorbidities have been extensively characterized in the low-dose CT literature and integrating screening of heavily tobacco-exposed cohorts with best practice tobacco cessation approaches has been shown to enhance the cost utility of low-dose CT screening (16). In addition, clinical interventions have already been developed by the cardiology community as the implications of coronary calcium status are well established (17).…”