Abstract 14347: Coronary Calcium, Carotid Atherosclerosis, and Ankle-brachial Index for Cardiovascular Prediction in Individuals With and Without Chronic Kidney Disease: The Multi-Ethnic Study of Atherosclerosis (MESA)
Background: Measures of subclinical atherosclerosis are recommended for cardiovascular disease (CVD) prediction to those with intermediate risk based on conventional predictors, but their performances have not been evaluated in individuals with chronic kidney disease (CKD).
Methods and Results: Among 6,553 participants aged 45-84 years without prior CVD in the Multi-Ethnic Study of Atherosclerosis (MESA), three representative subclinical measures, coronary artery calcium [CAC], carotid intima-media thickness [IMT], and ankle-brachial index [ABI], were compared for improvement of CVD prediction beyond the Framingham predictors in those with (n=1,284) and without CKD (kidney dysfunction or albuminuria). During a median follow-up of 8.4 years, there were 650 CVD events (coronary heart disease [CHD], stroke, heart failure [HF], and peripheral artery disease [PAD]) (236 events in CKD). Each subclinical measure was independently associated with CVD, with larger adjusted HRs (per 1 SD) for CAC than IMT and ABI in CKD (1.69 [95% CI, 1.45-1.97] vs. 1.12 [1.00-1.25] and 1.20 [1.08-1.32], respectively) and non-CKD (1.89 [1.69-2.12] vs. 1.19 [1.08-1.31] and 1.27 [1.16-1.40], respectively) populations. Compared to IMT and ABI, CAC contributed a greater c-statistic and a superior categorical net reclassification improvement (NRI) and integrated discrimination improvement (IDI) (Table ). When CVD subtypes were evaluated separately, regardless of CKD status, CAC outperformed IMT and ABI for CHD and HF prediction (e.g., c-statistic increment: 0.074 for CHD and 0.020 for HF by CAC vs. ≤0.006 by IMT and ABI for both outcomes in CKD). On the other hand, ABI best improved PAD prediction (c-statistic increment: 0.092 by ABI vs. ≤0.027 by CAC or IMT). Little improvement was observed for stroke with any of three measures.
Conclusions: CAC, IMT, and ABI improved CVD prediction in those with and without CKD, with the greatest improvement for CAC.
- © 2013 by American Heart Association, Inc.