Abstract 11701: The Ten Year Prognostic Value of Zero and Minimal Coronary Artery Calcium: The Multi-Ethnic Study of Atherosclerosis (MESA)
Introduction: Minimal and absent coronary artery calcium (CAC 1-10 and CAC=0) herald a very low risk for cardiovascular disease (CVD) events over 5 years. However, 10-year event rates, and predictors of CVD events in individuals with CAC 1-10 and CAC=0, are unknown.
Methods: MESA is a prospective, contemporary, multi-ethnic cohort of 6,814 subjects aged 45-84 years followed for incident CVD (stroke, MI, cardiac death). CVD event rates were estimated over a median follow-up of 10.3 years in 3,923 subjects with baseline CAC 0-10. Cox proportional hazards models were developed to estimate hazard ratios (HR) for the following baseline risk factors: age, gender, race, lipids, hypertension, diabetes, smoking, family history, CRP, and carotid intima media thickness. Event rates were stratified by 10-year risk categories from the 2013 ACC/AHA pooled ASCVD risk estimator.
Results: There were 123 CVD events over a median follow-up of 10.3 years with an overall event rate of 3.3/1,000 person years. Those with CAC 1-10 (n=508) experienced higher CVD event rates of 5.5/1,000 person years compared to 2.9/1,000 person years in 3,415 subjects with CAC=0 (RR 1.86; 95%CI: 1.16-2.89, p 0.004; Figure). In adjusted Cox models, decade of age (HR 1.65; 95%CI: 1.33-2.05, p<0.001), current smoking (HR 3.33; 95%CI: 2.07-5.35, p<0.001) and hypertension (HR 2.64; 95%CI: 1.71-4.05, p<0.001) significantly predicted CVD. NonHDL-cholesterol significantly predicted CVD only in those with CAC 1-10 (HR 1.54 per SD increase; 95%CI: 1.02-2.32, p 0.04) and not with CAC=0 (HR 1.07; 95%CI: 0.87-1.32, p 0.52). Event rates across risk categories are shown in the Figure.
Conclusions: Ten-year CVD event rates are very low in those with CAC 0-10. Minimal CAC (1-10) nearly doubles the 10-year risk compared with CAC=0 at baseline. Modifiable risk factors including current smoking and hypertension significantly predicted events in this group, while nonHDL-cholesterol only predicted CVD among those with CAC 1-10.
Author Disclosures: P.H. Joshi: None. M.J. Blaha: None. M.J. Budoff: None. M. Miedema: None. R. McClelland: None. J. Lima: Research Grant; Significant; Toshiba Medical Systems. A. Agatston: None. R. Blankstein: None. R. Blumenthal: None. K. Nasir: None.
- © 2014 by American Heart Association, Inc.