Detectable Coronary Artery Calcium Research Articles

Mammography-based deep learning model for coronary artery calcification.

Mammography, commonly used for breast cancer screening in women, can also predict cardiovascular disease. We developed mammography-based deep learning models for predicting coronary artery calcium (CAC) scores, an established predictor of coronary events. We evaluated a subset of Korean adults who underwent image mammography and CAC computed tomography and randomly selected approximately 80% of the participants as the training dataset, used to develop a convolutional neural network (CNN) to predict detectable CAC. The sensitivity, specificity, area under the receiver operating characteristic curve (AUROC), and overall accuracy of the model's performance were evaluated. The training and validation datasets included 5235 and 1208 women, respectively [mean age, 52.6 (±10.2) years], including non-zero cases (46.8%). The CNN-based deep learning prediction model based on the Resnet18 model showed the best performance. The model was further improved using contrastive learning strategies based on positive and negative samples: sensitivity, 0.764 (95% CI, 0.667-0.830); specificity, 0.652 (95% CI, 0.614-0.710); AUROC, 0.761 (95% CI, 0.742-0.780); and accuracy, 70.8% (95% CI, 68.8-72.4). Moreover, including age and menopausal status in the model further improved its performance (AUROC, 0.776; 95% CI, 0.762-0.790). The Framingham risk score yielded an AUROC of 0.736 (95% CI, 0.712-0.761). Mammography-based deep learning models showed promising results for predicting CAC, performing comparably to conventional risk models. This indicates mammography's potential for dual-risk assessment in breast cancer and cardiovascular disease. Further research is necessary to validate these findings in diverse populations, with a particular focus on representation from national breast screening programmes.

Progression of coronary artery calcification after radiation therapy for esophageal cancer.

Advances in cancer treatment have resulted in increased attention toward potential cardiac complications, especially following treatment for esophageal cancer, which is associated with a risk of coronary artery disease. As the heart is directly irradiated during radiotherapy, coronary artery calcification (CAC) may progress in the short term. Therefore, we aimed to investigate the characteristics of patients with esophageal cancer that predispose them to coronary artery disease, CAC progression on PET-computed tomography and the associated factors, and the impact of CAC progression on clinical outcomes. We retrospectively screened 517 consecutive patients who received radiation therapy for esophageal cancer from our institutional cancer treatment database between May 2007 and August 2019. CAC scores were analyzed clinically for 187 patients who remained by exclusion criteria. A significant increase in the Agatston score was observed in all patients (1 year: P = 0.001*, 2 years: P < 0.001*). Specifically for patients receiving middle-lower chest irradiation (1 year: P = 0.001*, 2 years: P < 0.001*) and those with CAC at baseline (1 year: P = 0.001*, 2 years: P < 0.001*), a significant increase in the Agatston score was observed. There was a trend for a difference in all-cause mortality between patients who had irradiation of the middle-lower chest ( P = 0.053) and those who did not. CAC can progress within 2 years after the initiation of radiotherapy to the middle or lower chest for esophageal cancer, particularly in patients with detectable CAC before radiotherapy initiation.

Study protocol of the InterVitaminK trial: a Danish population-based randomised double-blinded placebo-controlled trial of the effects of vitamin K (menaquinone-7) supplementation on cardiovascular, metabolic and bone health

IntroductionVitamin K has been suggested to have protective effects against progression of vascular calcification and development of cardiovascular disease (CVD). However, few well-powered randomised controlled trials have examined whether vitamin...

Abstract P337: Determinants and Influence of Breast Arterial Calcifications on Risk of Cardiovascular Disease

Background: Breast arterial calcifications (BAC) are incidentally observed on screening mammography. BAC has been shown to be associated with the presence of coronary artery calcification (CAC) and increased risk of coronary artery disease (CAD). Given that population-based mammography is currently recommended to women, the evaluation of BAC may be important in identifying high-risk women without additional cost or radiation exposure. Aims: We sought to identify reproductive and cardiovascular risk factors associated with the presence of detectable BAC and CAC in women participated to mammography screening. Also, we aimed to determine the association between BAC and presence of CAC. Further, we investigated presence of BAC, CAC and estimated 10-year risk of atherosclerotic cardiovascular disease (ASCVD). Methods: In this cross-sectional study, reproductive history and CVD risk factors were obtained in 215 women ≥ 18 years of age that underwent mammography and cardiac computed tomographic angiography (CCTA) within 2 years of each other between January 2007 and September 2017 at Weill Cornell Medicine/ New York Presbyterian hospital (WCM/NYP). BAC was recorded in two ways: a binary scale (presence/absence) and a semi-quantitative scale (mild, moderate, severe). CAC was calculated using the Agatston method and was recorded as a binary variable (presence/absence). Information regarding reproductive history and CVD risk factors, medical history, and relevant demographics were obtained by chart review. Odds ratios (ORs) and 95% confidence intervals (CIs), with adjustment for age at study entry as a potential confounder, were estimated. The 10-year risk of atherosclerotic cardiovascular disease (ASCVD) was calculated using the Pooled Cohort Risk Equations. Results: The odds of presence of BAC increased with increasing age . Women age ≥60 had a near 6-fold higher odds of BAC (OR = 5.77; 95% CI = 2.45 to 16.00) compared with women &lt;60 years old. Other factors associated with presence of BAC after controlling for age were diastolic blood pressure ≥80 ( P = 0.0008), systolic blood pressure ≥140 ( P = 0.0009), number of children (P = 0.01). Younger age at first birth (≤28 years) was associated with 3-fold higher odds of BAC compared with women with age at first birth &gt;28 years. Except for age at study entry, the only factor associated with presence of CAC was hyperlipidemia ( P = 0.002). We found no association between presence of BAC with CAC. We observed women with presence of both BAC and CAC had the highest estimated 10-year risk of ASCVD: 18.54%, followed by presence of BAC but absence of CAC 11.65%, absence of BAC and presence of CAC 6.01%, and women with no BAC and no CAC presence had a mean 10-year risk of ASCVD of 5.25%. Conclusions: These findings support the value of BAC in identifying women at potentially increased risk of future cardiovascular disease without additional cost and radiation exposure.

Coronary Artery Calcium Density and Cardiovascular Events by Volume Level: The MESA.

The Agatston coronary artery calcium (CAC) score provides robust cardiovascular disease risk prediction but upweights plaque area by a density factor. Density, however, has been shown to be inversely associated with events. Using CAC volume and density separately improves risk prediction, but it is unclear how to apply this method clinically. We aimed to evaluate the association between CAC density and cardiovascular disease across the spectrum of CAC volume to better understand how to incorporate these metrics into a single score. We performed an analysis of MESA (Multi-Ethnic Study of Atherosclerosis) participants with detectable CAC to evaluate the association between CAC density and events by level of CAC volume using multivariable Cox regression models. In a cohort of 3316 participants, there was a significant interaction (P<0.001) between CAC volume and density for coronary heart disease (CHD) risk (myocardial infarction, CHD death, resuscitated cardiac arrest). Models using CAC volume and density resulted in improvement in the C-index (0.703, SE 0.012 versus 0.687, SE 0.013) and a significant net reclassification improvement (0.208 [95% CI, 0.102-0.306]) compared with the Agatston score for CHD risk prediction. Density was significantly associated with lower CHD risk at volumes ≤130 mm3 (hazard ratio, 0.57 per unit of density [95% CI, 0.43-0.75]), but the inverse association at volumes >130 mm3 was not significant (hazard ratio, 0.82 per unit of density [95% CI, 0.55-1.22]). The lower risk for CHD associated with higher CAC density varied by level of volume, and volume ≤130 mm3 is a potentially clinically useful cut point. Further study is needed to integrate these findings into a unified CAC scoring method.

Incremental prognostic value of triglyceride glucose index additional to coronary artery calcium score in asymptomatic low-risk population

BackgroundThe triglyceride glucose (TyG) index has been suggested as a reliable surrogate marker of insulin resistance which is a substantial risk factor for atherosclerotic cardiovascular disease (ASCVD). Several recent studies have shown the relationship between the TyG index and cardiovascular disease; however, the role of the TyG index in coronary artery calcification (CAC) progression has not been extensively assessed especially in low-risk population.MethodsWe enrolled 5775 Korean adults who had at least two CAC evaluations. We determined the TyG index using ln (fasting triglycerides [mg/dL] x fasting glucose [mg/dL]/2). The CAC progression was defined as either incident CAC in a CAC-free population at baseline or an increase of ≥ 2.5 units between the square roots of the baseline and follow-up coronary artery calcium scores (CACSs) of subjects with detectable CAC at baseline.ResultsCAC progression was seen in 1,382 subjects (23.9%) during mean 3.5 years follow-up. Based on the TyG index, subjects were stratified into four groups. Follow-up CACS and incidence of CAC progression were markedly elevated with rising TyG index quartiles (group I [lowest]:17.6% vs. group II:22.2% vs. group III:24.6% vs. group IV [highest]: 31.3%, p < 0.001). In multivariate logistic regression analysis, the TyG index was independent predictor of CAC progression (odds ratio: 1.57; 95% confidence interval: 1.33 to 1.81; p < 0.001) especially in baseline CACS ≤ 100 group.ConclusionThe TyG index is an independent predictor of CAC progression in low-risk population. It adds incremental risk stratification over established factors including baseline CACS.

Sex-specific performance of the ASCVD pooled cohort equation risk calculator as a correlate of coronary artery calcium in Kampala, Uganda

Introduction: The prevalence of cardiovascular disease (CVD) is rising in Sub-Saharan Africa, but it is not known whether current risk assessment tools predict coronary atherosclerosis in the region. Furthermore, sex-specific performance and interaction with HIV serostatus has not been well studied. Methods: This cross-sectional study compared ASCVD risk scores and detectable coronary artery calcium (CAC>0) by sex in Kampala, Uganda (n = 200). The cohort was enriched for persons living with HIV, and all participants had at least one CVD risk factor. We fit log binomial regression models and constructed ROC curves to assess the correlation between ASCVD scores and CAC>0. Results: The mean age was 56. 62% were female and 50% of both men and women were living with HIV. The median 10-year ASCVD risk score was significantly higher in men (11.0%, IQR 7.6–19.4%) than in women (5.1%, IQR 3.2–8.7%), although the prevalence of CAC>0 was similar (8.1 vs 10.5%, p = 0.63). Each 10% increase in ASCVD risk was associated with increased risk of CAC>0 in men (PR 1.59, 95% CI 1.00–2.55, p = 0.05) but not women (PR 1.15, 95% CI 0.44–3.00, p = 0.77). ROC curves demonstrated an AUC of 0.57 for women vs 0.70 for men. Adjustment for HIV serostatus improved the predictive value of ASCVD in women only (AUC 0.78, p = 0.02). Conclusions: ASCVD risk score did not correlate with the presence of CAC in women. When HIV status was added to the ASCVD risk score, correlation with CAC was improved in women but not in men.

Coronary artery calcium and cardiovascular disease prediction by scanner type: the multi-ethnic study of atherosclerosis

To evaluate the predictive value of coronary artery calcium (CAC) scoring methods across cardiac computed tomography (CT) scanner types. CAC was measured in participants from the MESA (Multi-Ethnic Study of Atherosclerosis), a prospective cohort study of participants free of baseline cardiovascular disease (CVD), using either EBCT (electron beam CT) or MDCT (multidetector CT). The risks for incident coronary heart disease (CHD) and CVD events were compared for CAC scores per SD using Cox proportional hazards models with multivariable adjustment in 3,362 MESA participants with detectable CAC. Using the Agatston score, the hazard ratio (HR) and 95% confidence interval (CI) for CHD was 1.50 (1.27,1.78) for EBCT and 1.60 (1.37,1.87) for MDCT. Using volume and density scores, the HR for CHD was 2.14 (1.71,2.68) for volume and 0.61 (0.48,0.76) for density on EBCT and 1.73 (1.42,2.11) for volume and 0.88 (0.71,1.10) for density on MDCT. Similar results were seen for CVD risk and in analyses stratified by sex, body mass index (BMI), and age. The volume and density score model demonstrated higher areas under the curve (AUC) for CHD than the Agatston score with EBCT (0.702, 95% CI: 0.666,0.738 versus 0.677, 95% CI: 0.638,0.715, p<0.001) and MDCT (0.669, 95% CI: 0.632,0.705 versus 0.660, 95% CI: 0.622,0.697, p=0.216). The CAC volume and density scores provide better risk prediction than the Agatston score for CHD and CVD events, regardless of CT scanner type. CAC density was strongly and inversely associated with CHD risk. Both density and volume score prediction were stronger for EBCT than MDCT.

Predictors for coronary artery calcium score and differences in its distributions between populations with and without diabetes

Background and aims Coronary artery calcium (CAC) scoring is a method of measure coronary plaque burden and has been shown as an excellent predictor for atherosclerotic cardiovascular disease (ASCVD). Diabetes mellitus (DM) is an established risk factor for ASCVD, but a certain portion of patients with DM do not have CAC (score = 0). We conducted a study to identify predictors of the CAC score other than DM and to compare distributions of the score between populations with and without DM. Methods We included participants who were referred to receive CAC scanning at a large imaging center from July 1992 to July 2020. The distribution of the CAC scores and baseline characteristics were compared between participants with and without DM. Univariate logistic regressions followed by multivariate analysis were performed using CAC score &gt; 0 as outcome to identify independent factors contributing to the score. Results A total of 35,086 participants (mean age 58.9 ± 11.9 years, 63% male, 69% white) were included in the analysis. Of them, 11.8% had DM, 56% had hyperlipidemia, 38% had hypertension, and 7% were current smokers. A higher proportion of participants in the DM group had CAC score &gt; 0 (82% vs 62%, p &lt;0.01), but a substantial portion (18%) of DM patients had no CAC. Distribution of CAC score was also variable among participants with and without DM. Multivariate analysis showed that DM, age, male, hyperlipidemia, hypertension, and smoking were all independent predictors of CAC, and DM was associated with the second highest odds ratio (2.05, 95% confidence interval 1.87- 2.25) behind male (4.55, 95% confidence interval 4.17-4.76). Conclusions While DM was the second strongest predictor of CAC, nearly one fifth of persons with DM had no detectable CAC. Among DM patients, there is significant heterogeneity of scores, so an individualized approach to primary prevention for these patients is warranted.

Long-term Predictions of Incident Coronary Artery Calcium to 85 Years of Age for Asymptomatic Individuals With and Without Type 2 Diabetes.

To examine the utility of repeated computed tomography (CT) coronary artery calcium (CAC) testing, we assessed risks of detectable CAC and its cardiovascular consequences in individuals with and without type 2 diabetes ages 45-85 years. We included 5,836 individuals (618 with type 2 diabetes, 2,972 without baseline CAC) from the Multi-Ethnic Study of Atherosclerosis. With logistic and Cox regression we evaluated the impact of type 2 diabetes, diabetes treatment duration, and other predictors on prevalent and incident CAC. We used time-dependent Cox modeling of follow-up data (median 15.9 years) for two repeat CT exams and cardiovascular events to assess the association of CAC at follow-up CT with cardiovascular events. For 45 year olds with type 2 diabetes, the likelihood of CAC at baseline was 23% vs. 17% for those without. Median age at incident CAC was 52.2 vs. 62.3 years for those with and without diabetes, respectively. Each 5 years of diabetes treatment increased the odds and hazard rate of CAC by 19% (95% CI 8-33) and 22% (95% CI 6-41). Male sex, White ethnicity/race, hypertension, hypercholesterolemia, obesity, and low serum creatinine also increased CAC. CAC at follow-up CT independently increased coronary heart disease rates. We estimated cumulative CAC incidence to age 85 years. Patients with type 2 diabetes develop CAC at a younger age than those without diabetes. Because incident CAC is associated with increased coronary heart disease risk, the value of periodic CAC-based risk assessment in type 2 diabetes should be evaluated.

Prognostic Value of Coronary Artery Calcification Identified by the Semi-quantitative Weston Method in the Emergency Room or Other Hospitalized Patients.

Background: Coronary artery calcification (CAC) may provide insight to the patients' coronary artery disease (CAD) risks and influence early intervention. With increasing use of non-gated CT scans in clinical practice, the visual coronary artery scoring system (Weston Method) could quickly provide clinicians with important information of CAC for patient triage and management.Methods: We retrospectively studied the available CT imaging data and estimated CAC burden using the Weston method in 493 emergency room or other hospitalized patients. The Weston scores were calculated by the sum of the score for each vessel including the left main, left anterior descending, left circumflex artery and right coronary artery (range 0–12). The primary endpoint was a composite of the major adverse cardiac events (MACEs), including cardiac death, myocardial infarction, stroke, and coronary revascularization.Results: During a median follow-up of 85 months, a total of 25 (5.1%) MACE were recorded and 57 (11.2%) patients died from any causes. Detectable CAC was most common (96%) in the left anterior descending coronary arteries. Multivariable analysis showed that CAC total scores were independent predictors for MACE and all-cause mortality. Receiver operating characteristic analysis showed that CAC total score ≥5 was the optimal cutoff value for predicting MACEs.Conclusions: In the emergency room and hospitalized patients, the semi-quantitation of CAC burden using the Weston score system was related to the long-term cardiovascular outcomes including mortality. Clinicians and radiologists should maximize the value of non-contrast chest CT images by reporting CAC details.

FC 108BASELINE AND CORONARY ARTERY CALCIFICATION PROGRESSION MODULATES THE RISK OF DEATH IN INCIDENT TO DIALYSIS PATIENTS

Abstract Background and Aims It is estimated that Chronic Kidney Disease (CKD) accounts for 5 to 10 million deaths annually, mainly due to cardiovascular (CV) diseases. Although traditional CV risk factors are prevalent, other non-traditional CV risk factors such as vascular calcification (VC) are believed to contribute to this disproportionate CV risk burden in CKD subjects. We sought to investigate the association of Coronary Artery Calcification (CAC) progression with all-cause mortality in a cohort of patients new to hemodialysis (HD). Method This is a post hoc analysis of the Independent study (NCT00710788) originally designed to test the impact of 2 different phosphate binder regimens on various hard as well as surrogate endpoint in HD subjects. A total of 412 (88.4% of the Independent study cohort) underwent repeated CAC quantification according to the Agatston methods at study inception as well as after 12 months of follow-up. The square root method was used to assess CAC progression (CACP) and survival analyses were used to check the association of CACP and all-cause mortality. Results 412 middle age (65 years) men and women (51.2%) were considered. Detectable CAC was present in about 2 out 3 patients (68.2%) at study inception. At 12 months of follow-up completion, about 1 out of 3 subjects (33.1%) experience a significant CACP. CACP was associated with older age and use of calcium-based phosphate binders. At study completion (median follow-up: 36 months) 106 patients expired of all-cause. Age, diabetes mellitus, atherosclerotic CV events, baseline CAC extension were predictors of unfavorable outcome. Multivariable adjusted analysis confirmed an independent association of both baseline CAC (Hazard Ratio 1.29; 95% Confidence Interval: 1.17-1.44) and CACP (HR: 5.16; 95%CI: 2.61-10.21) with all-cause mortality. However, CACP diminished the risk associated with baseline CAC (p for interaction term 0.002) and use of calcium-free phosphate binders significantly weakened the link between CACP (HR. 1.95; 95%CI: 0.92-4.16) and mortality Conclusion Baseline CAC as well as CACP predict mortality in incident to HD individuals. Nevertheless, CACP mitigates the risk associated with baseline CAC and calcium-free phosphate binders attenuates the association of CACP and mortality, suggesting that CACP modulation may impact survival in this population

Dietary patterns associated with subclinical atherosclerosis: a cross-sectional analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) study.

To identify dietary patterns associated with subclinical atherosclerosis measured as coronary artery calcification (CAC). Cross-sectional analysis of data from the Brazilian Longitudinal Study of Adult Health. Dietary data were assessed using a FFQ, and a principal component factor analysis was used to derive the dietary patterns. Scree plot, eigenvalues > 1 and interpretability were considered to retain the factors. CAC was measured using a computed tomography scanner and an electrocardiography-gated prospective Ca score examination and was categorised into three groups based on the CAC score: 0, 1-100 and >100 Agatston units. Multinomial regression models were conducted for dietary patterns and CAC severity categories. Brazil, São Paulo, 2008-2010. Active and retired civil servants who lived in São Paulo and underwent a CAC exam were included (n 4025). Around 10 % of participants (294 men, 97 women) had a detectable CAC (>0), 6·5 % (182 men, 73 women) had a CAC of 1-100 and 3·5 % (110 men, 23 women) had a CAC > 100. Three dietary patterns were identified: convenience food, which was positively associated with atherosclerotic calcification; plant-based and dairy food, which showed no association with CAC; and the traditional Brazilian food pattern (rice, legumes and meats), which was inversely associated with atherosclerotic calcification. Our results showed that a dietary pattern consisting of traditional Brazilian foods could be important to reducing the risk of atherosclerotic calcification and prevent future cardiovascular events, whereas a convenience dietary pattern was positively associated with this outcome.

Triglyceride Glucose-Waist Circumference Better Predicts Coronary Calcium Progression Compared with Other Indices of Insulin Resistance: A Longitudinal Observational Study.

The triglyceride glucose (TyG) index, a product of triglyceride and fasting glucose, is a reliable marker for insulin resistance. We aimed to investigate the association between the TyG-related markers and coronary artery calcification (CAC) progression. We enrolled 1145 asymptomatic participants who underwent repeated CAC score measurements during routine health examinations. Homeostasis model assessment of insulin resistance (HOMA-IR), TyG index, TyG-BMI (body mass index), and TyG-WC (waist circumference) were calculated. Progression of CAC was defined as (1) incident CAC in a CAC-free population, or an (2) increase of ≥2.5 units between the baseline and final square root of the CAC scores in participants with detectable CAC. According to the quartiles of parameters, we stratified the subjects into four groups. The prevalence of progression increased with the TyG-WC quartile (15.0%, 24.1%, 31.0%, and 32.2% for each of the groups; p < 0.001). The multivariate-adjusted odds ratio (95% confidence interval) for CAC score progression was 1.66 (1.01–2.77) when the highest and lowest TyG-WC index quartiles were compared. Furthermore, the predictability of TyG-WC for CAC progression was better than the other indices in terms of the area under the curve. The TyG-WC index predicted CAC progression better than other indices and could be a potential marker of future coronary atherosclerosis.

Brief Report: Cystatin C-Based Estimation of Glomerular Filtration Rate and Association With Atherosclerosis Imaging Markers in People Living With HIV.

Reduced estimated glomerular filtration rate (eGFR) is associated with increased risk of cardiovascular disease among people living with HIV (PLWH). It is unclear whether eGFR equations incorporating cystatin C (CysC) measurements are more predictive of preclinical cardiovascular disease than those using only creatinine (Cr). The study aimed to determine which of the 3 Chronic Kidney Disease Epidemiology (CKD-EPI) eGFR equations is most associated with carotid intima media thickness (CIMT) and coronary artery calcium (CAC) score. This cross-sectional analysis of pooled data from 3 large cohorts compared the associations between the 3 CKD-EPI eGFR equations (Cr, CysC, and Cr-CysC) with CIMT and CAC score using multivariable regression analysis. eGFR and CIMT were analyzed as continuous variables. CAC scores were analyzed as a binary variable (detectable calcification versus nondetectable) and as a log10 Agatston score in those with detectable CAC. Thousand four hundred eighty-seven participants were included, and of these 910 (562 HIV+ and 348 HIV-) had CIMT measurements and 366 (296 HIV+ and 70 HIV-) had CAC measurements available. In HIV- participants, GFR estimated by any CKD-EPI equation did not significantly correlate with CIMT or CAC scores. When PLWH were analyzed separately including HIV-specific factors, only GFR estimated using Cr-Cys C correlated with CIMT [β= -0.90, 95% CI: (-1.67 to -0.13) μm; P = 0.023]. Similarly, eGFR correlated with Agatston scores only when using cystatin C-based eGFR [β= -8.63, 95% CI: (-16.49 to -0.77) HU; P = 0.034]. Associations between other eGFR formulas and CAC did not reach statistical significance. In PLWH, preclinical atherosclerosis may be more closely correlated with eGFR using formulae that incorporate CysC measurements than Cr alone.

Relation of Absence of Coronary Artery Calcium to Cardiovascular Disease Mortality Risk Among Individuals Meeting Criteria for Statin Therapy According to the 2018/2019 ACC/AHA Guidelines

The 2013 American College of Cardiology and the American Heart Association (ACC/AHA) guidelines resulted in broad recommendations for preventive statin therapy allocation in patients without known cardiovascular disease (CVD). Subsequent studies demonstrated significant heterogeneity of atherosclerotic cardiovascular disease risk across the primary prevention population. In 2018/2019, the guidelines were revised to optimize risk assessment and cholesterol management. We sought to evaluate the heterogeneity of risk in statin-recommended patients, using coronary artery calcium (CAC) according to 2018/2019 ACC/AHA guidelines in a primary prevention cohort. We evaluated 5,800 statin-naive patients aged 40 to 75 years without known coronary heart disease from the Cedars-Sinai Medical Center study cohort. All participants underwent clinical CAC scoring for risk stratification and were followed for all-cause and CVD-specific mortality. A total of 181 deaths occurred including 54 CVD deaths over a follow-up of 9.5 years. Overall, 1,939 participants would have been recommended statin therapy, 32% of whom had no detectable CAC. CAC = 0 participants had the lowest all-cause and CVD mortality rates in both statin-recommended and nonrecommended groups (0.2 and 0.4 CVD deaths per 1,000 person-years, respectively). Absence of CAC in statin-naive patients portends an approximately 12-fold lower CVD mortality (0.2% vs 2.4%) in those recommended for statin therapy compared with any CAC present. In conclusion, in a cohort of patients meeting the 2018/2019 ACC/AHA guidelines for statin therapy for primary prevention, there was a marked heterogeneity of CAC scores, with about one-third of the statin recommended population having no detectable CAC (CAC = 0) with a significantly lower CVD mortality compared with CAC>0.

Associations between Particulate Matter Air Pollution, Presence and Progression of Subclinical Coronary and Carotid Atherosclerosis: A Systematic Review

Abstract Background and aims Long-term exposure to particulate matter (PM) air pollution has been linked with increased cardiovascular events and mortality, however, studies had shown inconsistent associations between PM exposure and subclinical atherosclerosis. Methods We performed an updated systematic literature review to identify studies evaluating the associations between PM and subclinical atherosclerosis, measured using presence/progression of coronary artery calcium (CAC) or carotid intima-media thickness (CIMT) in adult populations. Quality was assessed using the Newcastle-Ottawa scale. Results Eighteen studies were included: 5 cohorts and 13 cross-sectional. Amongst 7 studies that evaluated the associations between PM and prevalence of CAC, 4 reported significantly higher odds of detectable CAC>0 or CAC>400 with increased PM exposure. Nine studies evaluated the association between exposure to at least one of the particulates and CIMT; of these, 6 reported significant independent associations. Two studies evaluated PM2.5 and CAC progression, with 1 reporting a greater progression of CAC with increased exposure to PM, while 3 out of 4 studies evaluating CIMT progression showed no significant difference in CIMT progression with a higher PM2.5 exposure. Additionally, 3 studies found significant associations between proximity to major roadways and measures of subclinical atherosclerosis. Among null studies, most displayed non-significant trends towards higher atherosclerosis burden with higher PM exposure. Conclusions Overall, available observational studies support a positive association between PM exposure and subclinical atherosclerosis. Further longitudinal studies are needed to better establish this relationship and assess the efficacy of previously identified interventions on mitigation of clinical cardiovascular disease.

Associations between particulate matter air pollution, presence and progression of subclinical coronary and carotid atherosclerosis: A systematic review

Background and aimsLong-term exposure to particulate matter (PM) air pollution has been linked with increased cardiovascular events and mortality, however, studies had shown inconsistent associations between PM exposure and subclinical atherosclerosis. MethodsWe performed an updated systematic literature review to identify studies evaluating the associations between PM and subclinical atherosclerosis, measured using presence/progression of coronary artery calcium (CAC) or carotid intima-media thickness (CIMT) in adult populations. Quality was assessed using the Newcastle-Ottawa scale. ResultsEighteen studies were included: 5 cohorts and 13 cross-sectional. Amongst 7 studies that evaluated the associations between PM and prevalence of CAC, 4 reported significantly higher odds of detectable CAC>0 or CAC>400 with increased PM exposure. Nine studies evaluated the association between exposure to at least one of the particulates and CIMT; of these, 6 reported significant independent associations. Two studies evaluated PM2.5 and CAC progression, with 1 reporting a greater progression of CAC with increased exposure to PM, while 3 out of 4 studies evaluating CIMT progression showed no significant difference in CIMT progression with a higher PM2.5 exposure. Additionally, 3 studies found significant associations between proximity to major roadways and measures of subclinical atherosclerosis. Among null studies, most displayed non-significant trends towards higher atherosclerosis burden with higher PM exposure. ConclusionsOverall, available observational studies support a positive association between PM exposure and subclinical atherosclerosis. Further longitudinal studies are needed to better establish this relationship and assess the efficacy of previously identified interventions on mitigation of clinical cardiovascular disease.

Association between atherogenic index of plasma and coronary artery calcification progression in Korean adults

BackgroundDyslipidemia is a well-known risk factor for cardiovascular disease (CVD). Recently, atherogenic index of plasma (AIP) has been proposed as a novel predictive marker for CVD, and few cross sectional studies have demonstrated a relationship between AIP and coronary artery disease. The present study investigated the association between AIP and the progression of coronary artery calcification (CAC) in Korean adults without CVD.MethodsA total of 1124 participants who had undergone CAC measurement at least twice by multi-detector computed tomography (CT) at a health check-up center were enrolled. Their anthropometric measurements and various cardiovascular risk factors were assessed. AIP was defined as the base 10 logarithm of the ratio of the concentration of triglyceride (TG) to high-density lipoprotein-cholesterol (HDL-C). CAC progression was defined as either incident CAC in a CAC-free population at baseline, or an increase of ≥2.5 units between the square roots of the baseline and follow-up coronary artery calcium scores (CACS) in subjects with detectable CAC at baseline.ResultsCAC progression was observed in 290 subjects (25.8%) during the mean follow-up of 4.2 years. All subjects were stratified into three groups according to AIP. There were significant differences in cardiovascular parameters among groups at baseline. The follow-up CAC and the incidence of CAC progression increased gradually with rising AIP tertiles. In logistic regression analysis, the odds ratio for CAC progression was 2.27 when comparing the highest to the lowest tertile of AIP (95% CI: 1.61–3.19; P for trend < 0.01). However, this association was attenuated after adjustment for multiple risk factors (P for trend = 0.67).ConclusionsThere is a significant correlation between AIP and the progression of CAC in subjects without CVD. Although AIP was not an independent predictor of CAC progression, AIP should be considered when estimating the current as well as future CVD risk, along with other traditional risk factors.

Atherosclerotic Cardiovascular Disease Risk Stratification Based on Measurements of Troponin and Coronary Artery Calcium

BackgroundLow values of high-sensitivity cardiac troponin (hs-cTn) and coronary artery calcium (CAC) scores of zero are associated with a low risk for atherosclerotic cardiovascular disease (ASCVD). ObjectivesThe purpose of this study was to evaluate baseline hs-cTnT and CAC in relation to ASCVD. MethodsBaseline hs-cTnT (limit of detection [LoD] 3 ng/l) and CAC measurements were analyzed across participants age 45 to 84 years without clinical cardiovascular disease from the prospective MESA (Multi-Ethnic Study of Atherosclerosis) in relationship to incident ASCVD. ResultsAmong 6,749 participants, 1,002 ASCVD events occurred during a median follow-up of 15 years. Participants with detectable CAC (20.1 vs. 5.0 events per 1,000 person-years; adjusted hazard ratio [HR]: 2.35; 95% confidence interval [CI]: 2.0 to 2.76; p < 0.001) and detectable hs-cTnT (15.4 vs. 5.2 per 1,000 person-years; adjusted HR: 1.47; 95% CI: 1.21 to 1.77; p < 0.001) had higher rates of ASCVD than those with undetectable results. Individuals with undetectable hs-cTnT (32%) had similar risk for ASCVD as did those with a CAC of zero (50%) (5.2 vs. 5.0 per 1,000 person-years). Together, hs-cTnT and CAC (discordance 38%) resulted in the following ASCVD event rates: hs-cTnT < LoD/CAC = 0: 2.8 per 1,000 person-years (reference), hs-cTnT ≥ LoD/CAC = 0: 6.8 per 1,000 person-years (HR: 1.59; 95% CI: 1.17 to 2.16; p = 0.003), hs-cTnT < LoD/CAC > 0: 11.1 per 1,000 person-years (HR: 2.74; 95% CI: 1.96 to 3.83; p < 0.00001), and hs-cTnT ≥ LoD/CAC > 0: 22.6 per 1,000 person-years (HR: 3.50; 95% CI: 2.60 to 4.70; p < 0.00001). ConclusionsAn undetectable hs-cTnT identifies patients with a similar, low risk for ASCVD as those with a CAC score of zero. The increased risk among those with discordant results supports their conjoined use for risk prediction.