Abstract 12300: Competing Cardiovascular Outcomes Associated with Presence of Subclinical Atherosclerosis: The Multi-Ethnic Study of Atherosclerosis (mesa)
Background: Subclinical atherosclerosis (SCA) in any vascular territory is associated with risk for multiple cardiovascular disease (CVD) outcomes simultaneously. We examined competing risks for diverse CVD outcomes to determine which events occur first, as a function of two SCA markers.
Methods: We included 3075 men and 3448 women from MESA, aged 45-84 years and free of clinical CVD from 4 ethnic groups. Participants (ppts) were stratified by coronary artery calcium (CAC) scores (CAC = 0, 1-99, and ≥ 100) and by a composite carotid intima media thickness (C-IMT) score (< 25th %ile, 25-75th%ile, and ≥ 75th %ile or ≥ 50% internal carotid artery stenosis). We used competing Cox models to determine competing cumulative incidences and hazards ratios within a group (e.g., among those with CAC ≥ 100) and hazards ratios for specific events between groups (e.g., CAC ≥ 100 vs. CAC = 0).
Results: The table shows data for women, stratified by CAC and C-IMT burden. In women, the 7-year hazards ratios (HR) for a CVD event compared with a non-CVD death occurring first for CAC = 0 and CAC ≥ 100 were 1.64 (95% CI, 1.06-2.52) and 3.75 (2.29-6.14), respectively. Coronary heart disease (CHD) was the most common first CVD event type at all levels of CAC and C-IMT, but there was substantially greater absolute and relative risk for CHD occurring first among those with the highest compared with the lowest levels of CAC and C-IMT. For example, CHD rates were 8.8% vs 1.3% (HR 6.30; 3.84-10.3) for women with CAC ≥100 compared with CAC=0; CHD rates were 6.3% vs 1.1% (HR 5.32; 2.61-10.8) for the highest vs lowest levels of C-IMT. Greater CAC and C-IMT burden were also associated with increased risk for stroke and heart failure as first events. We observed similar results in men.
Conclusion: Among individuals with higher levels of CAC or C-IMT, CHD was the most common first event. This analysis represents a novel approach to understanding the temporal sequence of cardiovascular complications associated with atherosclerosis.
- © 2011 by American Heart Association, Inc.