Abstract

Introduction: Coronary artery calcium (CAC) strongly predicts incident cardiovascular disease (CVD) beyond traditional risk factors. CAC volume and density can be determined separately. CAC volume is positively associated with CVD risk, whereas CAC density is inversely associated with CVD risk. Hypothesis: We assessed the hypothesis that traditional CVD risk factors would associate differently with CAC volume than with CAC density. Methods: Baseline measurements from 6814 community-dwelling participants free of known CVD were collected for the Multiethnic Study of Atherosclerosis between 2000 and 2002. The 3398 CAC-positive participants were included in these analyses. Multivariable linear regression models were used to evaluate independent risk factors for CAC volume and CAC density separately. Results and Conclusions: Standardized beta coefficients for risk factors significantly associated with increased CAC volume in the multivariable linear regression model included age (β=0.34), male gender (β=0.48), diabetes (β=0.38), current smoking (β=0.27), hypertension medication use (β=0.18), family history of MI (β=0.21), body mass index (β=0.17), total cholesterol (β=0.06), and reduced walking pace (β=0.12). Compared to the non-Hispanic white (NHW) reference group, Chinese (β=-0.62), African-American (β=-0.48), and Hispanic (β=-0.47) race/ethnicities had decreased CAC volume. Risk factors positively associated with increased CAC density in the multivariable linear regression model included HDL (β=0.03), and Chinese (β=0.39), African-American (β=0.16), and Hispanic (β=0.18) race/ethnicities in comparison with NHW. Diabetes (β=-0.10) and body mass index (β=-0.08) were both inversely associated with CAC density. In conclusion, CVD risk factors predicted both increased CAC volume and decreased CAC density, suggesting they could increase atherosclerotic risk both by increasing CAC volume and decreasing CAC density. Ethnic groups other than NHW had lower risk CAC plaques, with lower volume and greater density.

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