Low Coronary Artery Calcium Score Research Articles

Non-Calcified Plaque Burden Is Associated With Increased Major Adverse Cardiovascular Events In A High Risk Appalachian Population With Low Coronary Artery Calcium Scores (0-100)

Non-Calcified Plaque Burden Is Associated With Increased Major Adverse Cardiovascular Events In A High Risk Appalachian Population With Low Coronary Artery Calcium Scores (0-100)

Association between body composition and coronary artery calcification in patients with chronic kidney disease

Objective: To investigate the association between body composition and coronary artery calcification in patients with chronic kidney disease (CKD). Methods: This cross-sectional study enrolled patients with CKD hospitalized from May 2019 to April 2022 at Sun Yat-sen Memorial Hospital, Guangzhou, China. Skeletal muscle mass index and visceral fat area were measured by bioelectrical impedance analysis. Coronary artery calcification was assessed by computed tomography. Patients were divided into coronary artery calcification group and non-coronary artery calcification group according to the incidence of coronary artery calcification. Patients were categorized into tertile groups according to their skeletal muscle mass index and visceral fat area levels ranging from the lowest to the highest levels (T1 to T3). We defined skeletal muscle mass index≤30.4% as low muscle mass and visceral fat area≥80.6 cm2 as high visceral fat based on the results of the restricted cubic spline graph. All individuals were divided into 4 phenotypes: normal body composition, low muscle mass, high visceral fat, and low muscle mass with high visceral fat. Spearman correlation analysis and logistic regression analysis were used to assess the association between skeletal muscle mass index, visceral fat area and coronary artery calcification. Results: A total of 107 patients with CKD were enrolled, with an age of (60.0±14.1) years, including 41 female patients (38.3%). Patients of coronary artery calcification group had lower skeletal muscle mass index ((32.0±4.8) vs. (34.3±4.8), P=0.016) and higher visceral fat area ((70.8±32.6) cm2 vs. (47.9±23.8) cm2, P<0.001) than those of non-coronary artery calcification group. Patients in the T3 group of skeletal muscle mass index had a lower prevalence of coronary artery calcification (17 (48.6%) vs. 28 (77.8%)) and a lower coronary artery calcification score (0.5 (0, 124.0) vs. 12.0 (0.3, 131.0)) than those in the T1 group (P<0.05). Similarly, patients in the T1 group of visceral fat area had a lower prevalence of coronary artery calcification (14 (40.0%) vs. 29 (80.6%)) and a lower coronary artery calcification score (0 (0, 3.0) vs. 37.0 (2.0, 131.0)) than those in the T3 group (P<0.05). Likewise, patients with both low muscle mass and low muscle mass with high visceral fat had a higher prevalence of coronary artery calcification (11(78.6%) vs. 33 (47.8%); 15 (83.3%) vs. 33 (47.8%)) and a higher coronary artery calcification score (31.1 (0.8, 175.8) vs. 0 (0, 16.4); 27.6 (6.4, 211.4) vs. 0 (0, 16.4)) than those with normal body composition (P<0.05). Spearman correlation analysis showed that skeletal muscle mass index was inversely correlated with coronary artery calcification score (r=-0.212, P=0.028), and visceral fat area was positively correlated with coronary artery calcification score (r=0.408, P<0.001). Multivariate logistic regression analysis showed that increased skeletal muscle mass index was inversely associated with coronary artery calcification prevalence (T2: OR=0.208, 95%CI: 0.056-0.770, P=0.019; T3: OR=0.195, 95%CI: 0.043-0.887, P=0.034), and reduced visceral fat area was inversely associated with coronary artery calcification prevalence (T1: OR=0.256, 95%CI: 0.071-0.923, P=0.037; T2: OR=0.263, 95%CI: 0.078-0.888, P=0.031). Consistently, both low muscle mass and low muscle mass with high visceral fat were associated with coronary artery calcification prevalence (OR=6.616, 95%CI: 1.383-31.656, P=0.018; OR=5.548, 95%CI: 1.062-28.973, P=0.042). Conclusion: Reduced skeletal muscle mass index and increased visceral fat area are significantly associated with both the prevalence and severity of coronary artery calcification in patients with CKD.

Impact of Arterial Calcification on Cardiovascular and Renal Outcomes in Kidney Transplant Patients

Plain Language SummaryArterial calcification, accumulation of calcium in the arterial walls, vascular stiffness, and loss of elasticity of blood vessels can contribute to the development of cardiovascular diseases. Patients with chronic kidney disease and those undergoing dialysis have a considerably increased risk of vascular calcification. Even after kidney transplantation when kidney function has been restored, the prevalence of vascular calcification and subsequent cardiovascular disease remains high. Coronary artery calcification score and abdominal aortic calcification score are both well-established markers of vascular calcification. However, the impact of pretransplant vascular calcification scores on cardiovascular and renal outcomes in kidney transplant patients has not been established. When we analyzed 944 Korean kidney transplant patients, both vascular calcification scores were significantly associated with cardiovascular outcomes after kidney transplantation, but were not associated with renal outcomes. We also demonstrated that the addition of coronary artery calcification scores led to a modest improvement in the prediction performance for kidney transplant outcomes. Our findings suggest a potential role of pretransplant screening of coronary calcification scores and aortic calcification scores in risk stratification for post-kidney transplant outcomes.

A meta-analysis comparing the diagnostic performance of computed tomography-derived fractional flow reserve and coronary computed tomography angiography at different levels of coronary artery calcium score.

The impact of coronary calcification on the diagnostic accuracy of computed tomography-derived fractional flow reserve (CT-FFR) and coronary computed tomography angiography (CCTA) remains a crucial consideration. This meta-analysis aims to compare the diagnostic performance of CT-FFR and CCTA at different levels of coronary artery calcium score (CACS). We searched PubMed, Embase, and the Cochrane Library for relevant articles on CCTA, CT-FFR, and invasive fractional flow reserve (FFR). Ten studies were included to evaluate the diagnostic performance of CT-FFR and CCTA at the per-patient and per-vessel levels in four CACS groups. Invasive FFR was used as the reference standard. Except for the CACS ≥ 400 group, the AUC of CT-FFR was higher than those of CCTA in other subgroups of CACS (in CACS < 100 (per-patient, 0.9 (95% CI 0.87-0.92) vs. 0.32 (95% CI 0.28-0.36); per-vessel, 0.92 (95% CI 0.89-0.94) vs. 0.66 (95% CI 0.62-0.7); both p < 0.001), CACS ≥ 100 (per-patient, 0.86 (95% CI 0.82-0.88) vs. 0.44 (95% CI 0.4-0.48); per-vessel, 0.88 (95% CI 0.85-0.9) vs. 0.51 (95% CI 0.46-0.55); both p < 0.001), and CACS < 400 (per-patient, 0.9 (95% CI 0.87-0.93) vs. 0.74 (95% CI 0.7-0.78), p < 0.001; per-vessel, 0.8 (95% CI 0.76-0.83) vs. 0.74 (95% CI 0.7-0.78); p = 0.02)). CT-FFR demonstrates superior diagnostic performance in low CACS groups (CACS < 400) than CCTA in detecting hemodynamic stenoses in patients with coronary artery disease (CAD). Computed tomography-derived fractional flow reserve might be utilized to determine the necessity of invasive coronary angiography in coronary artery disease patients with coronary artery calcium score < 400. • There is a lack of meta-analysis comparing the diagnostic performance of computed tomography-derived fractional flow reserve and coronary computed tomography angiography at different levels of calcification. • Computed tomography-derived fractional flow reserve only has a better diagnostic performance than coronary computed tomography angiography with low amounts of coronary calcium. • For the low coronary artery calcium score group, computed tomography-derived fractional flow reserve might be a good non-invasive method to detect hemodynamic stenoses in coronary artery disease patients.

Predictors of coronary atherosclerosis in middle-aged and older endurance athletes

Abstract Background Exercise improves cardiovascular health, but emerging evidence indicates that coronary atherosclerosis is more prevalent in middle-aged and older endurance athletes than sedentary peers. It has been shown that greater lifelong exercise volumes and exercise training at a very vigorous intensity are associated with higher coronary artery calcification scores (CACS). Nevertheless, the underlying mechanisms responsible for accelerated coronary atherosclerosis in veteran athletes are unknown and largely unexplored. Purpose To identify predictors of CACS in middle-aged and older endurance athletes. Methods Cardiac CT scans were performed on 284 middle-aged and older male athletes of the MARC-2 study to assess CACS. Participants were stratified to CACS=0, CACS: 1-100, CACS: 101-400, or CACS &amp;gt;400. Participant characteristics, traditional cardiovascular risk factors, biomarker concentrations, nutrition characteristics, perceived stress scores, and usage of immune-modulating and performance-enhancing drugs were compared across CACS subgroups, whereas linear regression with backward elimination was used to determine associations with ln(CACS + 1). Results Participants were 60.0 [Q1-3 56.3-66.0] years old, had a weekly training load of 25.7 [16.9-35.2] MET-h, BMI of 24.5 [22.9-26.7] kg/m2, systolic blood pressure (SBP) of 140±18 mmHg, and reported 0.3 [0.0-8.0] smoking pack years. CACS was 31 [0-132], with 29% of athletes having CACS of 0, 40% 1-100, 18% 101-400, and 13% &amp;gt;400. Participants with CACS &amp;gt;400 were older (p&amp;lt;0.001), had higher SBP (p=0.004), had smoked more pack years (p=0.003), and had more often a family history of cardiovascular disease (p=0.001), compared to lower CACS groups. After backward selection, our final multivariable model (R2=0.12) revealed that alcohol intake (p=0.021), smoking pack years (p=0.027), and SBP (p=0.004) had a positive relationship with CACS, while total fat intake (p=0.005) had an inverse relationship with CACS. We also found a significant interaction effect between weekly training load with alcohol consumption (p=0.017) and SBP (p=0.028), indicating that the association of alcohol and SBP with CACS was stronger for individuals performing higher exercise volumes. Conclusion Alcohol consumption, smoking history, and SBP were the strongest predictors of CACS in our cohort of middle-aged and older male endurance athletes, whereas the effect size of alcohol consumption and SBP on CACS was larger for participants with higher training loads. Our findings indicate that high exercise volumes do not eliminate the cardiovascular risk associated with an unhealthy lifestyle.

Abstract 13946: Predictive Value of FDG-PET/CT Derived Coronary Artery Calcium Scoring in Non-Small Cell Lung Cancer Patients

Introduction/Background: Coronary artery calcium (CAC) scoring on PET-CT has emerged as a potential prognostic tool in patients with cancer. Research Question/Hypothesis: CAC determined using non-ECG gated PET-CT data is a useful predictor of major adverse cardiac events (MACE) and overall survival in non-small cell lung cancer (NSCLC) patients. Goals/Aims: To investigate the association between CAC scores, MACE, and survival outcomes in NSCLC patients. Methods/Approach: We retrospectively analyzed baseline staging PET-CT (n=130) or CT (n=24), clinical history, demographics, and follow-up survival data of NSCLC patients. Patients were divided into four groups based on their CAC scores according to the 2016 SCCT/STR guidelines. Cox regression analysis was performed to assess the association between CAC score and survival, CAC score and MACE, and smoking history and survival. Results/Data: The mean age of the population was 66.3 ± 10.8 years with 42.9% never smokers. Of the 154 patients evaluated, 49.3% died during a mean follow-up period of 3.5 years. Cox regression analysis revealed a trend toward improved survival rates of patients with lower CAC scores (P= 0.081 for No/Minimal risk and P= 0.039 for Mild group). Current or prior smoking was significantly associated with decreased survival (P = .013, HR = 1.8). Logistic regression analysis showed a significant inverse relationship between CAC scores and MACE (n=32) for no risk/minimal (P = .001) and mild risk (P &lt; .001) groups. Additionally, there was an inverse association between CAC and number of observed acute MI for no /minimal risk group (P= .02) and mild risk group (P= .003). Conclusion: Our findings suggest that lower CAC scores, measured at initial staging PET-CT, are associated with decreased MACE and acute MI in NSCLC patients. Further studies are needed to validate these findings and explore the potential of CAC scoring as a routine prognostic tool in NSCLC management.

Coronary Artery Calcium Score as a Sensitive Indicator of Cardiovascular Disease in Patients with Type 2 Diabetes Mellitus: A Long-Term Cohort Study.

Coronary artery calcium score (CACS) has become an important tool for evaluating cardiovascular disease (CVD). This study evaluated the significance of CACS for future CVD through more than 10 years of follow-up in asymptomatic Korean populations with type 2 diabetes mellitus (T2DM) known to have a relatively low CACS burden. We enrolled 981 asymptomatic T2DM patients without CVD at baseline who underwent CACS evaluation using multidetector computed tomography between January 2008 and December 2014. They were grouped into five predefined CACS categories based on Agatston scores and followed up by August 2020. The primary endpoint was incident CVD events, including coronary, cerebrovascular, and peripheral arterial disease. The relative risk of CVD was significantly higher in patients with CACS ≥10, and the significance persisted after adjustment for known confounders. A higher CACS category indicated a higher incidence of future CVD: hazard ratio (95% confidence interval) 4.09 (1.79 to 9.36), 12.00 (5.61 to 25.69), and 38.79 (16.43 to 91.59) for 10≤ CACS <100, 100≤ CACS <400, and CACS ≥400, respectively. During the 12-year follow-up period, the difference in event-free survival more than doubled as the category increased. Patients with CACS below 10 had very low CVD incidence throughout the follow-up. The receiver operating characteristic analysis showed better area under curve when the CACS cutoff was 10 than 100. CACS can be a sensitive marker of CVD risk. Specifically, CACS above 10 is an indicator of CVD high-risk requiring more intensive medical treatment in Koreans with T2DM.

Is coronary artery calcium an independent risk factor for white matter hyperintensity?

BackgroundCardiovascular diseases have been considered the primary cause of disability and death worldwide. Coronary artery calcium (CAC) is an important indicator of the severity of coronary atherosclerosis. This study is aimed to investigate the relationship between CAC and white matter hyperintensity (WMH) in the context of diagnostic utility.MethodsA retrospective analysis was conducted on 342 patients with a diagnosis of WMH on magnetic resonance images (MRI) who also underwent chest computed tomography (CT) scans. WMH volumes were automatically measured using a lesion prediction algorithm. Subjects were divided into four groups based on the CAC score obtained from chest CT scans. A multilevel mixed-effects linear regression model considering conventional vascular risk factors assessed the association between total WMH volume and CAC score.ResultsOverall, participants with coronary artery calcium (CAC score > 0) had larger WMH volumes than those without calcium (CAC score = 0), and WMH volumes were statistically different between the four CAC score groups, with increasing CAC scores, the volume of WMH significantly increased. In the linear regression model 1 of the high CAC score group, for every 1% increase in CAC score, the WMH volume increases by 2.96%. After including other covariates in model 2 and model 3, the β coefficient in the high CAC group remains higher than in the low and medium CAC score groups.ConclusionIn elderly adults, the presence and severity of CAC is related to an increase in WMH volume. Our findings suggest an association between two different vascular bed diseases in addition to traditional vascular risk factors, possibly indicating a comorbid mechanism.

Correlation of neck circumference, coronary calcification severity and cardiovascular events in Chinese elderly patients with acute coronary syndromes

Background and aimsWe aimed to investigate whether neck circumference (NC) can predict metabolic syndrome (MetS), coronary calcification and lesion, and major adverse cardiovascular events (MACEs). MethodsA total of 867 patients with acute coronary syndrome (ACS) over 60 years old from the Second Hospital of Shandong University, who had undergone coronary computed tomography, were randomly selected for a retrospective analysis. The subjects were divided into male and female groups, NC quartile 1–4 groups (Q1-Q4 groups), non-multivessel coronary disease (non-MVCD) and multi-vessel coronary disease (MVCD) groups. ResultsAfter adjusting for potential confounders, NC was associated with risk factors promoting coronary artery disease (CAD) and coronary artery calcification score (CACS). The severity of CAD increased by 0.202 times and 0.372 times for each unit of NC in male and female groups, respectively. Compared with the lower CACS group, the risk of coronary calcification increased by 0.139 times, and MVCD increased 0.268 times, with each unit increase of NC. Except for all-cause death, there were significant differences between the Q1-Q4 groups in the prevalence of all primary endpoints, cardiogenic death, unexpected re-hospitalization of heart failure, ACS recurrence or unplanned revascularization, and non-fatal stroke (p log-rank <0.01). In view of the overall trend, with the increase of NC quartiles, the prevalence of MACEs gradually increased (all p < 0.01). ConclusionsNC is closely associated with MetS and its components, coronary calcification and lesion degree, and MACEs. NC could be used as surrogate of CACS to predict the coronary condition and prognosis of elderly patients with ACS.

Higher exercise capacity, but not omega-3 fatty acid consumption, predicts lower coronary artery calcium scores in women and men with coronary artery disease

Background and aimsHigher coronary artery calcium (CAC) scores are associated with increased cardiovascular (CVD) events and mortality. Exercise capacity is predictive of CVD events. Our aim was to examine the relationship between exercise capacity and CAC in women and men. MethodsCAC was measured in 203 men and 38 women with clinical coronary artery disease using multidetector coronary tomography. They were randomized to 3.36 g eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) daily or none for 30 months. Maximal exercise treadmill testing was performed at baseline with calculation of metabolic equivalents of task (METs) achieved as a measure of exercise capacity. ResultsDespite similar ages at baseline (64.0 ± 6.7 vs 62.7 ± 7.8 years, respectively, p = 0.225), women had lower CAC scores compared to men: 106.7 Agatston units [AU] vs 535.3, respectively, p < 0.001, and at every age (p < 0.001). Female CAC scores did not equal those of men until women were 20 years older. Higher levels of METs were associated with lower CAC scores in both women and men. After multivariate adjustment, METs was the most important predictor of CAC score in women at baseline and 30 months (p = 0.001 and 0.029, respectively) whereas only age predicted in men (p = 0.019 and 0.004, respectively). Annual CAC progression was significantly greater in men compared to women (94.8 AU/year vs 38.0, respectively, p = 0.014). No difference was observed in CAC progression in the EPA + DHA group compared to control in either men or women. ConclusionsThe association of higher METs with lower CAC scores in both women and men supports recommending exercise to maximize cardiorespiratory fitness as this may minimize CAC scores and thus, potentially decrease risk for CVD events. This may be especially important for women since METs independently predicted baseline and 30 month CAC in women.

Predictors of left ventricular mass and coronary artery calcium phenotypes

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): National Medical Research Council, Ministry of Health, Singapore and the Lee Foundation Background Left ventricular (LV) mass and coronary artery calcium score (CACS) are both independent predictors of cardiovascular risk. There is paucity of data on the interplay of risk factors on LV mass in the presence or absence of subclinical coronary atherosclerosis. Purpose The objective of this present study was to explore the relationship of risk factors to indexed LV mass and CACS in a healthy Southeast-Asian population. Methods This study recruited volunteers with no known cardiovascular disease. LV mass, measured by cardiovascular magnetic resonance, was indexed to body surface area (LVMI), and CACS determined by non-contrast CT scanning. Blood pressure (BP) was measured via both office and ambulatory monitoring, and physical activity assessed through wearable devices. Analysis of LVMI was stratified into high, normal and low defined as more than one standard deviation away from the mean for each sex, with inter-group differences evaluated using chi-squared or ANOVA statistical tests. Subjects in each LVMI group were further subdivided by the presence and absence of coronary calcification (total 6 subgroups; LVMI/CACS phenotypes). Results A total of 880 subjects were included, including 428 males and 452 females. There was no significant difference in prevalence of coronary calcification across the LVMI groups for males, while females with high LVMI had significantly greater proportion of positive CACS (p = 0.036). Higher LVMI was observed in younger male subjects, but not in females. In both sexes, body mass index was positively associated with LVMI (p = 0.004 for males, p = 0.037 for females), but not CACS. Waist circumference was associated with higher LVMI in males only. Greater amounts of weekly self-reported exercise (p = 0.006) and daily calories burned (p = 0.022) were associated with increased LVMI for males only. However, wearable-derived measures of daily physical activity and step counts did not significantly affect LVMI or LVMI/CACS phenotypes in both sexes. BP was a strong predictor of LVMI in both sexes regardless of office or ambulatory readings, in both day and night-time. The association was also observed with LVMI/CACS phenotypes: higher systolic or diastolic BP was significantly associated with positive CACS across all risk groups. Notably, subjects with low LVMI and positive CACS were normotensive (office BP 129/82 for males, 123/77 for females). Higher HDL cholesterol levels correlated to absence of coronary calcification in males only (p = 0.010). In females, lower levels of total (p = 0.001) and LDL (p = 0.005) cholesterol were associated with absence of coronary calcification across all LVMI categories. Conclusion Only BP was strongly associated with LVMI and LVMI/CACS phenotypes in both sexes. There appears to be no correlation between physical activity and LVMI/CACS phenotypes. There is a need for causative studies to better evaluate the varying influence of risk factors on LVMI and CACS.

Testosterone is positively associated with coronary artery calcium in a low cardiovascular disease risk population.

In industrialized populations, low male testosterone is associated with higher rates of cardiovascular mortality. However, coronary risk factors like obesity impact both testosterone and cardiovascular outcomes. Here, we assess the role of endogenous testosterone on coronary artery calcium in an active subsistence population with relatively low testosterone levels, low cardiovascular risk and low coronary artery calcium scores. In this cross-sectional community-based study, 719 Tsimane forager-horticulturalists in the Bolivian Amazon aged 40+ years underwent computed tomography (49.8% male, mean age 57.6 years). Coronary artery calcium levels were low; 84.5% had no coronary artery calcium. Zero-inflated negative binomial models found testosterone was positively associated with coronary artery calcium for the full sample (Incidence Rate Ratio [IRR] = 1.477, 95% Confidence Interval [CI] 1.001-2.170, P = 0.031), and in a male-only subset (IRR = 1.532, 95% CI 0.993-2.360, P = 0.053). Testosterone was also positively associated with clinically relevant coronary atherosclerosis (calcium >100 Agatston units) in the full sample (Odds Ratio [OR] = 1.984, 95% CI 1.202-3.275, P = 0.007) and when limited to male-only sample (OR = 2.032, 95% CI 1.118-4.816, P = 0.024). Individuals with coronary artery calcium >100 had 20% higher levels of testosterone than those with calcium <100 (t = -3.201, P = 0.007). Among Tsimane, testosterone is positively associated with coronary artery calcium despite generally low normal testosterone levels, minimal atherosclerosis and rare cardiovascular disease (CVD) events. Associations between low testosterone and CVD events in industrialized populations are likely confounded by obesity and other lifestyle factors.

Abstract 10410: Association Between Coronary Artery Calcium Scoring With Statin Initiation, Cholesterol Reduction and Cardiovascular Outcomes in Black Patients

Introduction: Coronary artery calcium (CAC) scoring is a cost-effective and reproducible method to assess risk for cardiovascular (CV) outcomes and is particularly important for guiding prevention in asymptomatic patients. Black patients are at high risk for atherosclerotic cardiovascular disease (ASCVD) that is not fully explained by traditional risk factors. In this study, we investigated the prevalence of CAC and its association with CV events in Black and white individuals. Methods: We investigated the baseline characteristics, rates of statin initiation, changes in cholesterol, and major adverse CV events (myocardial infarction, stroke, death) in 49,799 patients with self-reported race (Black or white) who underwent CAC scoring in the CLARIFY study between 2014 and 2020 (Clinicaltrials.gov NCT04075162). Results: In total, there were 4,292 Black patients and 45,507 white patients. Compared with white patients, Black patients had similar age (P=0.17), were more likely to be female (60.5% vs 50%, P&lt;0.001), had higher 10-year ASCVD risk by pooled cohort equation (16.18% vs. 11.06%, P&lt;0.001), lower LDL cholesterol (115 vs 123 mg/dL, P&lt;0.001), and were more likely to have CAC of 0 (49.2% vs 39.9%, P&lt;0.001). At every 10-year ASCVD risk category by pooled cohort equation, CAC was more prevalent in white patients than Black patients (p&lt;0.001). Despite similar statin initiation post CAC score in patients not on statins at baseline, Black patients had less relative reduction in LDL cholesterol over 1 year compared with white patients (figure). Within each CAC category, Black patients had higher rates of CV events (P&lt;0.003) over 1 year. Conclusions: In this large cohort of patients undergoing CAC scoring, Black individuals had lower CAC scores despite having higher predicted ASCVD risk and worse outcomes. Black individuals had less relative reduction in cholesterol over 1 year compared with white individuals, despite having similar statin initiation rates.

Coronary artery calcium and risk of chronic kidney disease in young and middle-aged adults.

The role of the coronary artery calcium score (CACS) in incident chronic kidney disease (CKD) in asymptomatic young populations remains unclear. The aim of this study was to evaluate the association between CACSs and CKD development in adults. A cohort study of 113171 Korean adults (mean age 40.6years) without CKD and proteinuria at baseline who underwent a cardiac tomography estimation of CACSs during health screening examinations was performed (median follow-up 4.2years). The outcome was CKD, defined as an estimated glomerular filtration rate (eGFR) <60ml/min/1.73m2 and/or the presence of proteinuria. Hazard ratios (HRs) and 95% confidence intervals (CIs) for CKD were estimated using Cox proportional hazards regression analyses. A higher CACS was moderately associated with an increased risk of CKD in a dose-dependent manner. The multivariable-adjusted HRs for CKD comparing CACSs 1-100, 101-300 and >300 with a CACS of 0 were 1.15 (95% CI 1.05-1.25), 1.37 (95% CI 1.13-1.66) and 1.71 (95% CI 1.32-2.22), respectively (P for trend <.001). When CKD was defined using low eGFR and proteinuria separately, corresponding HRs for low eGFR were 1.31 (95% CI 1.05-1.62), 1.41 (95% CI 0.95-2.11) and 1.86 (95% CI 1.16-3.00), respectively (P for trend=.001), while the HRs for proteinuria were 1.11 (95% CI 1.02-1.21), 1.32 (95% CI 1.07-1.64) and 1.57 (95% CI 1.16-2.12), respectively. A higher CACS was progressively associated with an increased risk of CKD, even at low CACSs. Individuals with a CACS >0 appear to have an increased risk of CKD and may benefit from preventive measures to reduce CKD risk.

Cholesterol mass efflux capacity and coronary artery calcium: The Multi-Ethnic Study of Atherosclerosis

We assessed the cross-sectional and longitudinal relationships of high-density lipoprotein (HDL)-mediated cholesterol mass efflux capacity (CMEC) with coronary artery calcium (CAC) score and CAC density. CMEC was measured in 1626 Multi-Ethnic Study of Atherosclerosis (MESA) participants in samples obtained between 2000 and 2002 as part of two nested case-control studies, one with cases of incident cardiovascular disease and the other with cases of carotid plaque progression by ultrasound. Cardiac CT examinations for the presence of CAC were performed at baseline and at two additional examinations. CAC scores (Agatston and volume) and density scores (for those with positive CAC) were calculated. Multivariable linear regression modeling per SD increment of CMEC was used to estimate the associations of CMEC with each of these CAC measures. We found no association between higher CMEC and either lower CAC scores or a higher CAC density. We also found no association between higher CMEC and progression of any of these CAC measures. These findings suggest that HDL-mediated cholesterol efflux may be associated with cardiovascular risk via mechanisms unrelated to burden of calcified plaque.

Age-stratified effects of coronary artery calcification on cardiovascular and non-cardiovascular mortality in Korean adults.

The role of coronary artery calcium score (CACS) in predicting cardiovascular disease (CVD) and non-CVD mortality in young adults is unclear. We investigated the association of CACS with CVD and non-CVD mortality in young and older individuals. CVD-free Koreans (n = 160 821; mean age, 41.4 years; 73.2% young individuals aged <45 years) who underwent cardiac tomography estimation of CACS (69.7% one-time measurement), were followed-up for a median of 5.6 years. The vital status and cause of death were ascertained from the national death records. Sub-distribution hazard ratios (SHR) and 95% confidence intervals (CIs) for cause-specific mortality were estimated using the Fine and Gray proportional hazards models. Overall, a higher CACS was strongly associated with an increased risk of CVD mortality. Among young individuals, multivariable-adjusted SHR (95% CIs) for CVD mortality comparing a CACS of 1-100, 101-300, and >300 to 0 CACS were 5.67 (2.33-13.78), 22.34 (5.72-87.19), and 74.1 (18.98-239.3), respectively, and among older individuals, corresponding SHR were 1.51 (0.60-3.84), 8.57 (3.05-24.06), and 6.41 (1.98-20.74). The addition of CACS to Framingham risk score significantly but modestly improved risk prediction for CVD mortality in young individuals. Conversely, CACS was significantly associated with non-CVD mortality only in older individuals. Strong associations of CACS with CVD mortality, but not non-CVD mortality, were observed in young individuals, beginning in the low CACS category. Our findings reaffirm the need for early intervention for young adults even with low CACS to reduce CVD mortality.

Gender Differences in Patients With Stable Chest Pain

This study sought to investigate gender differences in clinical presentation, presence, and extent of coronary artery disease (CAD), and all-cause mortality in patients with stable chest pain who underwent coronary computed tomography angiography (CCTA). Patients who visited the fast-track outpatient clinic of the Erasmus Medical Center and underwent CCTA were analyzed. Clinical characteristics of chest pain, CAD on CCTA, coronary artery calcium scores, and survival were collected retrospectively and compared between men and women. Logistic regression was used to identify independent risk factors for the presence of CAD and Cox regression for all-cause mortality. In 1,835 included patients, 966 (52.6%) were female. Men and women were similar in age (55 vs 56years). Compared with men, women had a lower frequency of typical pain (22.8% vs 31.1%, p<0.001), lower prevalence of significant CAD (22.2% vs 38.1%, p<0.001), and lower coronary artery calcium scores (p <0.001). CAD was more prevalent in men than in women with typical pain (67.4% vs 35.9%, p<0.001) and also with nontypical pain (24.9% vs 18.1%, p=0.002). After adjustment for baseline characteristic, male sex was associated with all-cause mortality (adjusted hazard ratio 1.87, 95% confidence interval 1.25 to 2.80, p=0.002). The additional risk of mortality because of CAD was similar between men and women. Stratifying by typical and nontypical pain, women again had a better prognosis. Our study identifies gender-related differences in characteristics, CCTA-findings, and outcomes for women compared with men presenting for CCTA with chest pain. Women have less CAD and a better prognosis than men, the clinical implications of which require further study.

Effect of lanthanum carbonate on the progression of coronary artery calcification in hemodialysis patients: A meta-analysis of randomized controlled trials.

Coronary artery calcification and cardiac abnormalities are common in hemodialysis patients. The value of lanthanum carbonate over calcium-based phosphate binders in managing the progression of coronary artery calcification is debated. We reviewed all randomized controlled trials (RCTs) comparing the two strategies in these patients. RCTs comparing lanthanum carbonate with calcium-based phosphate binders used in adult hemodialysis patients were identified in the PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, China Science and Technology Journal, and Wanfang databases. Ten RCTs involving 687 patients were suitable for inclusion. Compared with calcium-based phosphate binders, lanthanum carbonate yielded lower coronary artery calcium scores (weighted mean difference, WMD: -74.28, 95% CI: -149.89, 1.33), change in coronary artery calcium scores (WMD: -105.18, 95% CI: -113.83, -96.53), and left ventricular mass index (WMD: -29.95, 95% CI: -54.25, -7.45). Lanthanum carbonate was significantly associated with lower levels of serum phosphate (WMD: -0.18, 95% CI: -0.26, -0.10), calcium (WMD: -0.22, 95% CI: -0.25, -0.20), and fibroblast growth factor 23 (FGF23) (standard mean difference: -3.78, 95% CI: -5.60, -1.96) but not intact parathyroid hormone (WMD: -4.23, 95% CI: -64.12, 55.65). Moreover, a reduced risk of nonfatal cardiovascular events (OR: 0.31, 95% CI: 0.10-0.97) but not all-cause mortality (OR: 1.08, 95% CI: 0.39-3.01) in lanthanum carbonate therapy was observed. In hemodialysis patients, lanthanum carbonate therapy may impede the progression of coronary artery calcification and left ventricular mass index and lead to reduced serum phosphate, calcium, FGF23, and nonfatal cardiovascular events compared with calcium-based phosphate binders. However, more well-designed RCTs are required for confirmation.

Associations of Red Cell Distribution Width With Coronary Artery Calcium in the General Population.

Red cell distribution width (RDW) is a measure of the variability of erythrocyte volumes. RDW has been associated with incidence of cardiovascular diseases. However, the underlying mechanisms for the increased cardiovascular risk are still unclear. This study aimed to examine associations of RDW and coronary atherosclerosis in the general population. Computed tomography was performed and RDW was measured in fresh blood from 5772 subjects (aged 50–64 years) from the Swedish CArdioPulmonary bioImage Study (SCAPIS). Multinomial logistic regression was conducted to examine the associations between RDW and coronary artery calcium score (CACS). A total of 3902 (67.6%) individuals had low CACS (≤10), 18.6% had moderate CACS (>10 and ≤100) and 13.8% had high CACS (>100). The proportion with high CACS was 11.7%, 12.7%, 13.7% and 18.3%, respectively, in quartile 1–4 of RDW. After controlling for traditional risk factors, there were significant associations between RDW and high CACS: odds ratio = 1.51, 95% confidence interval: 1.18–1.94, and P = .001, for 4th vs 1st quartile of RDW. Elevated RDW is associated with coronary artery calcification in the middle-aged general population. RDW could be a reproducible and easily assessable biomarker of coronary calcification and cardiovascular risk.

Abstract 12277: Concordance of High Polygenic CAD Risk Score With High Coronary Artery Calcium Score &amp; Low Polygenic CAD Risk Score With Low Coronary Artery Calcium Score: A Real World Experience

Introduction: Genetic predisposition for CAD is well established. Polygenic risk scores are emerging as tools which attempt to quantify the genomic component of an individual’s risk for CAD. However, clinical utility for individual risk stratification is unclear. Hypothesis: 180 SNPs previously identified in Caucasian Genome Wide-Association Studies for CAD were used to construct a weighted restricted polygenic risk score (PRS; normalized range 11.18 -17.58). This study hypothesizes that high PRS (&gt;=85th percentile) is associated with high (&gt;400) coronary artery calcium (CAC) score, &amp; a low PRS(&lt; 85th percentile) is associated with low (&lt;100) CAC. Methods: Between January 2018 and March 2020, 21,784 patients underwent CAC screening and/or PRS testing. Caucasian patients with both PRS and CAC scores were reviewed. Patients with CAC 100-400 were excluded. Fisher’s exact test for high/low PRS and high/low CAC was utilized. Results: 2,752 patients were identified to have low (&lt;100) or high (&gt;400) CAC; 306 (11.1%) had a high CAC (table 1). Odds ratio of high PRS associated with high CAC and low PRS associated with low CAC was 1.54 (95% CI: 1.07-2.19; p=0.017). Conclusion: Our real-world experience in a Caucasian cohort shows that high PRS is associated with a high CAC, as is a low PRS with low CAC. Concordance between PRS and CAC lends support for incorporating PRS in the clinical setting, especially for early identification of individuals at high risk for CAD. Larger, ethnically diverse studies are needed.