Abstract
Introduction: Initiation of coronary artery calcium (CAC) is an important milestone associated with a marked increase in cardiovascular disease (CVD) risk. However, traditional risk factors do not perform well for CVD risk stratification among older persons. Hypothesis: Contrasting to measures of subclinical CVD, blood-based non-traditional risk factors will not strongly predict incident CAC in older adults. Methods: There were 815 participants > 65 years old with CAC=0 at Visit 1. We calculated multivariable Cox hazards ratios and C-statistics for the association of non-traditional risk factors with incident CAC. Results: The mean age was 70.2 years old, 67% were women, and 35% were Black. A total of 55% developed incident CAC with a median follow-up time to incident CAC of 3.6 years. The largest proportion of persons with incident CAC was among those with microalbuminuria (Figure). Albuminuria (aHR=1.54, 95% CI: 1.10-2.16) and thoracic calcification (TAC) (aHR=1.38, 95% CI: 1.10-1.75) were significantly associated with incident CAC, while 1-SD higher level of apolipoprotein-B, lipoprotein(a), high-sensitivity troponin T, N-terminal pro-brain natriuretic peptide and C-reactive protein were not. When added to demographic information, albuminuria and TAC provided a greater C-statistic improvement (+0.044, p=0.01) versus all traditional risk factors combined (+0.029, p=0.09). Conclusions: Among non-traditional risk factors and measures of subclinical CVD, only albuminuria and TAC were significantly associated with incident CAC in persons >65 years old. Identification of older persons with albuminuria or TAC may help guide the utility and timing of repeat CAC scoring in older persons with baseline CAC=0.
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