Abstract
Background: Ideal cardiovascular health (CVH) is associated with a lower incidence of cardiovascular disease (CVD). Extra-coronary calcification (ECC) – measured at the aortic valve (AVC), mitral annulus (MAC), ascending thoracic aorta (ATAC) and descending thoracic aortic (DTAC) – is an indicator of systemic atherosclerosis. However, the association between ideal CVH and ECC is unknown. This study examined whether favorable CVH was associated with a lower risk of ECC. Methods: We analyzed data from 6,504 men and women aged 45-84 years from MESA, a multi-ethnic cohort free of CVD at baseline. Extra-coronary calcification [AVC, MAC, ATAC and DTAC] was measured by non-contrast cardiac CT scan at baseline and after an average of 2.4 years. Prevalent and incident ECC were defined as an Agatston score >0. Each CVH metric (smoking, physical activity, body mass index, diet, blood pressure, total cholesterol and blood glucose) was scored 0-2 points, with 2 indicating “ideal”, 1 “intermediate” and 0 “poor”. The maximum CVH score attainable ranged from 0-14 points (inadequate score: 0-8; average: 9-10; optimal: 11-14). We used Poisson regression and linear mixed-effect models to examine the association between CVH and ECC adjusted for age, sex, race/ethnicity, education, income, health insurance and study site. Results: The mean (SD) age of participants was 62 (10) years, 53% were women, 39% White, 12% Chinese American, 26% Black and 22% Hispanic. Optimal and average CVH scores were associated with a lower prevalence and incidence of ECC as well as lower ECC extent at baseline compared to inadequate scores (Table). In addition, optimal and average CVH scores were associated with less ECC progression at 2 years although the associations were only significant for MAC and DTAC. Conclusion: In this multi-ethnic cohort, favorable CVH was associated with a lower risk of developing extra-coronary atherosclerosis. These findings underscore the importance of primordial prevention as an intervention to reduce the burden of CVD.
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