Favorable Cardiovascular Health Is Associated With Lower Prevalence, Incidence, Extent, and Progression of Extracoronary Calcification: MESA

Abstract

Background: Ideal cardiovascular health (CVH) is associated with a lower incidence of cardiovascular disease. Extracoronary calcification (ECC)—measured at the aortic valve, mitral annulus, ascending thoracic aorta, and descending thoracic aorta—is an indicator of systemic atherosclerosis. This study examined whether favorable CVH was associated with a lower risk of ECC. Methods: We analyzed data from MESA (Multi-Ethnic Study of Atherosclerosis) participants aged 45 to 84 years without cardiovascular disease at baseline. ECC was measured by noncontrast cardiac computed tomography scan at baseline and after an average of 2.4 years. Prevalent ECC was defined as an Agatston score >0 at the baseline scan. Incident ECC was defined as Agatston score >0 at the follow-up scan among participants with Agatston score of 0 at the baseline scan. Each CVH metric (smoking, physical activity, body mass index, diet, blood pressure, total cholesterol, and blood glucose) was scored 0 to 2 points, with 2 indicating ideal; 1, intermediate; and 0, poor. The aggregated CVH score was 0 to 14 points (0–8, inadequate; 9–10, average; 11–14, optimal). We used Poisson and linear mixed-effects regression models to examine the association between CVH and ECC adjusted for sociodemographic factors. Results: Of 6504 participants, 53% were women with a mean age (SD) of 62 (10) years. Optimal and average CVH scores were associated with lower ECC prevalence, incidence, and extent. For example, optimal CVH scores were associated with 57%, 56%, 70%, and 54% lower risk of incident aortic valve calcification, mitral annulus calcification, ascending thoracic aorta calcification, and descending thoracic aorta calcification, respectively. In addition, optimal and average CVH scores were associated with lower ECC progression at 2 years, although these associations were only significant for mitral annulus calcification and descending thoracic aorta calcification. Conclusions: In this multiethnic cohort, favorable CVH was associated with a lower risk of extracoronary atherosclerosis. These findings emphasize the importance of primordial prevention as an intervention to reduce the burden of cardiovascular disease.

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Extra Coronary Calcium: Should We Measure All That Meets the Eye?

“…In this issue of Circulation: Cardiovascular Imaging , Ogunmoroti et al 2 add to the literature by evaluating the association of cardiovascular health (CVH) with the overall burden and progression of ECC. The authors stratified participants of MESA (Multi-Ethnic Study of Atherosclerosis), a population-based cohort study of 6814 adults without known CVD, based on their CVH score.…”

“…3 Numerous prior studies have consistently shown that the CVH score is associated with meaningful clinical outcomes—adults with more favorable CVH scores have a significantly lower burden of subclinical disease and experience fewer incident cardiovascular events than adults with poor scores. 4–7 Ogunmoroti et al 2 determined whether MESA participants with more favorable CVH also had a lower burden of ECC at baseline and slower progression over a mean of 2.4 years follow-up. ECC sites were mitral annular calcification, aortic valve calcification (AVC), ascending thoracic aorta (ATAC), and descending thoracic aorta (DTAC).…”