Predictive Value of Electron Beam Computed Tomography of the Coronary Arteries

Arad, Yadon; Spadaro, Louise A.; Goodman, Ken; Lledo-Perez, Alfonso; Sherman, Scott; Lerner, Gail; Guerci, Alan D.

doi:10.1161/01.cir.93.11.1951

Cited by 472 publications

(212 citation statements)

References 11 publications

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“…34 -36 Coronary calcium has also been found to predict mortality 37 and CHD events. [37][38][39] These findings confirm that coronary calcium is a marker of atherosclerosis and suggest that it is a useful tool in studying the origins of atherosclerotic heart disease. Of additional interest, hostility has been found to be associated with coronary calcification in this population.…”

Section: Discussionsupporting

confidence: 58%

Prevalence and Correlates of Coronary Calcification in Black and White Young Adults

Bild

Folsom

Lowe

et al. 2001

ATVB

136

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Abstract-Whereas cardiovascular risk factor levels are substantially different in black and white Americans, the relative rates of cardiovascular disease in the 2 groups are not always consistent with these differences. To compare the prevalence of coronary calcification, an indicator of coronary atherosclerosis, in young adult blacks and whites, we performed electron-beam computed tomography of the heart in 443 men and women aged 28 to 40 years recruited from a population-based cohort. The presence of calcium, defined as at least 1 focus of at least 2.05 mm 2 in area and Ͼ130 Hounsfield units in density within the coronary arteries, was identified in 16.1% of black men, 11.8% of black women, 17.1% of white men, and 4.6% of white women (Pϭ0.04 for comparison across groups). Coronary calcium was associated with age and male sex, and after adjustment for age, race, and sex, coronary calcium was positively associated with body mass index, weight, systolic blood pressure, total cholesterol, low density lipoprotein cholesterol, triglycerides, and fasting insulin and negatively associated with education (all PϽ0.05). Independent risk factors included male sex, body mass index, and low density lipoprotein cholesterol. Race was not significantly associated with coronary calcium in men or women, before or after adjustment for risk factors. Coronary calcification is associated with increased levels of cardiovascular risk factors in young adults, and its prevalence is not significantly different in blacks and whites. Key Words: coronary heart disease Ⅲ risk factors Ⅲ race Ⅲ coronary artery calcification R elative levels of coronary risk factors in blacks and whites suggest that blacks would be at higher risk for coronary heart disease (CHD). 1-6 CHD mortality rates appear to reflect higher risk factor levels in blacks, 7 but CHD incidence is lower in black men than in white men. 8 Clues to possible racial differences in rates of CHD may be found by identifying subclinical disease for which treatment has not been instituted and which is not subject to the biases of disease ascertainment or death certificate coding. 9 -12 To compare the prevalence of a marker of coronary atherosclerosis in a population-based sample of young adult blacks and whites, to examine risk factor correlates, and to determine whether any racial differences in prevalence might be explained by risk factor differences, we measured coronary calcification by using electron-beam computed tomography (EBCT) of the heart and risk factors in men and women aged 28 to 40 years who have participated in an ongoing epidemiological study of the coronary disease risk factors. Coronary calcium is a specific marker for coronary atherosclerosis 13 and can be quantified by EBCT. 14 -16 Methods ParticipantsParticipants in the present study were from the Coronary Artery Risk Development in Young Adults (CARDIA) Study. The baseline CARDIA examination took place from 1985 to 1986 and included 5115 women and men from 4 centers (Birmingham, Ala; Chicago, Ill; Minneapolis, Min...

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Section: Discussionsupporting

confidence: 58%

Prevalence and Correlates of Coronary Calcification in Black and White Young Adults

Bild

Folsom

Lowe

et al. 2001

ATVB

136

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“…14,15 The extent of coronary calcification in the coronary arteries has been associated with a substantial increase in risk of clinical coronary heart disease. 16,17 The amount of calcification found on EBCT examination was much greater in women who had coronary heart disease compared with women without this disease. 15 Thus, in the 50-to 59-year age group, only 14% of women without clinical coronary artery disease had coronary calcium compared with 40% of the women with a history of or symptomatology related to clinical coronary artery disease.…”

mentioning

confidence: 98%

Coronary and Aortic Calcification Among Women 8 Years After Menopause and Their Premenopausal Risk Factors

Kuller

Matthews

Sutton-Tyrrell

et al. 1999

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132

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Abstract-In the Healthy Women Study, the relationship between cardiovascular risk factors measured premenopausally at age 48, use of hormone therapy, and coronary and aortic calcification at age 58 were evaluated among 169 women. Approximately 63% of women had no coronary calcification, but only 29% had no aortic calcification. Coronary calcification and aortic calcification were positively correlated with each other. There was a very strong association between low density lipoprotein cholesterol (LDL-C) level and coronary calcification. Among women with premenopausal levels of LDL-C Ͻ100 mg/dL, only 9% had a coronary calcium score Ն101 compared with 30% of women with an LDL-C Ͼ160 mg/dL. Only 5% of women with a high density lipoprotein cholesterol (HDL-C) level Ͼ60 mg/dL had high coronary scores. The level of HDL 2 -C was especially strongly inversely related to coronary calcium scores. Cigarette smoking was a very important determinant of both high aortic and high coronary calcium scores. Other risk factors associated with greater coronary calcium were higher systolic blood pressure, triglycerides levels, and blood glucose. Use of hormone replacement therapy was associated with less coronary calcium (NS). For both hormone replacement therapy users and nonusers, the levels of LDL-C and HDL-C measured premenopausally were predictors of coronary and aortic calcium scores. Thus, risk factors evaluated premenopausally are powerful predictors of coronary and aortic calcification, a marker of atherosclerosis, measured 8 years after menopause, 11 years later in these women. Key Words: coronary artery disease Ⅲ coronary calcification Ⅲ lipids Ⅲ smoking Ⅲ hormone replacement therapy T he development of new techniques to measure the extent of subclinical cardiovascular disease, such as carotid duplex scanning and electron beam CT (EBCT), has provided important new approaches to study the relationship of risk factors and cardiovascular disease. In this article, we report the relationship between cardiovascular risk factors measured premenopausally and coronary and aortic calcification for 168 women, as measured by EBCT, in the Healthy Women Study (HWS) at the eighth postmenopausal visit. 1,2 In previous reports from the HWS, we evaluated the determinants of changes in cardiovascular risk factors from the premenopause, perimenopause, and postmenopause. 3 There was an increase in LDL cholesterol (LDL-C), little change in total HDL-C, a substantial decline in HDL 2 -C, and an increase in HDL 3 -C. The women gained Ϸ1 pound per year from the perimenopause through the postmenopausal years. Weight gain was associated with a substantial increase in LDL-C, triglycerides, and systolic blood pressure and a decrease in HDL-C levels. 4 In this article, we evaluated 2 hypotheses. First, we predicted that the cardiovascular risk factors that predict clinical cardiovascular disease in elderly women would also predict coronary and aortic calcification in middle-aged women. The extensive risk factor assessment was completed when the women...

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“…[15][16][17][18] The National Heart, Lung, and Blood Institute (NHLBI) recently put forward an RFP (request for proposals) using EBCT, among other noninvasive methods, to study subclinical cardiovascular disease (RFP-…”

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confidence: 99%

Electron Beam Computed Tomographic Coronary Calcium Scanning: A Review and Guidelines for Use in Asymptomatic Persons

Rumberger

Brundage²,

Rader

et al. 1999

Mayo Clinic Proceedings

742

449

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Predictive Value of Electron Beam Computed Tomography of the Coronary Arteries

Abstract: Coronary EBCT predicts future atherosclerotic cardiovascular disease events in asymptomatic subjects.

Cited by 472 publications

References 11 publications

Prevalence and Correlates of Coronary Calcification in Black and White Young Adults

Prevalence and Correlates of Coronary Calcification in Black and White Young Adults

Coronary and Aortic Calcification Among Women 8 Years After Menopause and Their Premenopausal Risk Factors

Electron Beam Computed Tomographic Coronary Calcium Scanning: A Review and Guidelines for Use in Asymptomatic Persons

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