Abstract P375: Coronary Artery Structural Remodeling by Computed Tomography and Cardiovascular Disease; the Coronary Artery Risk Development in Young Adults (CARDIA) Study

Abstract

Background: Glagov identified cross-sectional enlargement and maintenance of the lumen of the coronary artery (CA) in post-mortem studies as an early feature of atherosclerotic coronary heart disease (CHD) that precedes the development of stenosis, coronary artery calcium (CAC) and plaque rupture. This structural change in the CA wall has been termed positive remodeling. We hypothesized that larger CA cross-sectional areas, consistent with positively remodeled CA, is associated with prevalent or soon-to-be incident coronary heart disease (CHD) and cardiovascular disease (CVD) events. Methods: In 2946 black and white male and female CARDIA participants aged 42-56 years, who had thin-slice (<1 mm), ECG gated, non-contrast coronary CT in 2010-2011, we measured CA cross-sectional area (CSA) in the proximal epicardial CA at 24 pre-specified locations. The mean of all measurements was calculated to provide a summary of all CA (CA CSA_all ). We performed logistic regression with medical-record adjudicated CVD prevalence (n=96) or incidence in the following 3 years (n=27) as the outcome, predicted from this estimate of positive remodeling adjusting for age, race, sex, presence of coronary artery calcium (CAC), and amount of pericardial fat as covariates. Results: CA CSA_all had a mean ± SD 21.2 ± 6.7 mm 2 . The adjusted odds ratio (OR) for having any CVD was 1.06 (95% CI 1.03-1.09, p<0.0001) per mm 2 (Table). ORs for CVD increased across quartiles of CA CSA_all . Corresponding OR for any coronary heart disease (n=66) was not significant, but was significant for stroke (n=42) and for heart failure (n=27). Further adjustment for traditional risk factors assessed in 2010-2011 did not alter these estimates substantially. Conclusion: Individuals with larger CA cross-sectional areas had increased odds of CVD, stroke, and heart failure, but not CHD, independent of CAC and pericardial fat. CA CSA_all may be an imaging biomarker of coronary positive remodeling and provide new insight into progression from subclinical to premature clinical CVD.