Abstract 13530: Multisite Atherosclerosis and Cardiovascular Event Risk: The Multiethnic Study of Atherosclerosis
Background: Subclinical cardiovascular disease (CVD) measures, including coronary (CAC) and aortic calcification (AAC), carotid intimal medial thickness (CIMT), and ankle-brachial index (ABI) individually relate to increased CVD event risk. We examined how information from these together relate to CVD event risk.
Methods: We studied 1775 adults aged 46-88 (21% African-American, 25% Hispanic, 13% Chinese, and 40% Caucasian) without CVD in the Multiethnic Study of Atherosclerosis who had measures of CAC, AAC, CIMT (average of maximum common and internal CIMT), and ABI available with mean follow-up of 4.74 years for CVD events (nonfatal and fatal coronary heart disease and stroke) following Exam 2-3. We examined the number of measures positive (based on CAC>0, AAC>0, CIMT>1 mm, and ABI<1.0 or >1.5 for borderline/elevated) as well as a composite score based on the sum of quantity of CAC and AAC (0 if absent, or 1-4 for non-zero quartiles), CIMT (quintiles 0-4), and ABI (1.0-<1.5 scored 0; 1-4 for decreasing quartiles below 1.0 and 1 for ABI>1.5). Cox regression, adjusted for age, gender, and risk factors examined the relation of number of areas positive (0-1, 2, 3, or 4) and the composite score (measured continuously and in quartiles) with incident CVD events.
Results: 18.8% of subjects had 0, 23.7% one, 31.0% two, 22.7% three, and 3.8% all four areas positive for atherosclerosis. Over the follow-up, 89 CVD events occurred. CVD events per 1000 person years varied from 3.0 to 57.5 among those with 0-1 to all 4 areas positive (table). Per standard deviation of composite score (range 0-16), the adjusted HR for CVD events was 2.11 (1.59, 2.79), but higher in women: 2.85 (1.73, 4.71) than in men: 1.76 (1.25, 2.49). HR’s also rose dramatically with the number and/or extent of vascular beds affected by atherosclerosis (table)
Conclusion: The burden of subclinical CVD from multiple vascular territories is strongly related to future CVD events, and to a greater degree in women than in men.
- © 2012 by American Heart Association, Inc.