Abstract 12350: Burden of Atherosclerosis Predicts Coronary Heart Disease but Not Cerebrovascular Events
Introduction: Since atherosclerosis is a systemic process, risk prediction would benefit from targeting several components of cardiovascular disease (CVD) simultaneously. To this end, it is useful to examine the predictive value of non-invasive measures of atherosclerosis in multiple vascular beds for both coronary heart disease (CHD) and cerebrovascular events.
Hypothesis: We assessed the hypothesis that coronary artery, aortic arch and carotid artery calcium scoring is of additional value beyond traditional risk factors in the risk prediction of both CHD and cerebrovascular disease.
Methods: The study comprised 2,153 asymptomatic participants (69.6±6.6 years) from the Rotterdam Study that underwent a multi-detector computed tomography (MDCT) scan. During a median follow-up of 3.5 years, 79 CHD events and 52 cerebrovascular events occurred. Associations of coronary artery, aortic arch and carotid artery calcification with CHD and cerebrovascular events were examined. Furthermore, participants were classified into low (<5%), intermediate (5–10%) and high (>10%) 5-year risk categories based on a Framingham refitted risk model. Thereafter, the model was extended either by coronary artery, aortic arch or carotid artery calcium and reclassification percentages were calculated.
Results: Calcification of the coronary arteries, aortic arch and carotid arteries was associated with a substantially increased risk of CHD. Moreover, all three measures of calcification significantly improved CHD risk prediction beyond Framingham risk factors. Reclassification was most substantial in the intermediate risk group where addition of coronary artery calcium, aortic arch and carotid artery calcium respectively reclassified 61%, 32% and 56% of participants, at good calibration. The net reclassification improvement (NRI) was 0.25 (P < 0.001), 0.13 (P = 0.01) and 0.16 (P < 0.01) for the three measures, respectively. In contrast, calcification in these vascular beds had no clear association with the risk of cerebrovascular events and did not improve risk prediction of cerebrovascular disease.
Conclusions: Coronary artery, aortic arch and carotid artery calcification significantly improved risk prediction of CHD but not of cerebrovascular events.
- © 2010 by American Heart Association, Inc.