Prevalence Of Coronary Artery Calcium Score Research Articles

Relation between Coronary Artery Calcium Score and Cardiovascular Events in Hodgkin Lymphoma Survivors: A Cross-Sectional Matched Cohort Study.

Thoracic radiotherapy is one of the corner stones of HL treatment, but it is associated with increased risk of cardiovascular events. As HL is often diagnosed at a young age, long-term follow-up including screening for coronary artery disease (CAD) is recommended. This study aims to evaluate the presence of coronary artery calcium score (CACS) in relation to cardiovascular events in HL patients treated with thoracic radiotherapy compared to a non-cancer control group. Consecutive HL patients who underwent evaluation for asymptomatic CAD with coronary computed tomography angiography > 10 years after thoracic irradiation were included. The study population consisted of 97 HL patients matched to 97 non-cancer patients on gender, age, cardiovascular risk factors, and statin use. Mean age during CT scan in the HL population was 45.5 ± 9.9 and in the non-cancer population 45.5 ± 10.3 years. CACS was elevated (defined as >0) in 49 (50.5%) HL patients and 30 (30.9%) control patients. HL survivors had an odds ratio of 2.28 [95% CI: 1.22-4.28] for having a CACS > 0 compared to the matched population (p = 0.006). Prevalence of CACS > 90th percentile differed significantly: 17.1% in HL survivors vs. 4.6% in the matched population (p = 0.009). Non-obstructive coronary artery stenosis was more prevalent in the HL population than in the control population (45.7% vs. 28.4%, respectively, p = 0.01). During follow-up of 8.5 [5.3; 9.9] years, nine HL patients experienced an event including two patients with a CACS of zero. No events occurred in the control population. In a matched study population, HL survivors have a higher prevalence of a CACS > 0 and an increased risk of cardiovascular events after thoracic irradiation compared to a matched non-cancer control group.

Limitations of Cardiovascular Risk Scores in Primary Prevention. An Opportunity for Risk Modulators?

Background: Cardiovascular risk scores have limitations related to calibration, discrimination, and low sensitivity. Different "risk modulators" have been identified to improve cardiovascular risk stratification: carotid atherosclerotic plaque (CAP), coronary artery calcium (CAC) score and lipoprotein(a) [Lp(a)]. Objectives: The aims of this study were: 1) to determine the prevalence of risk modulators mentioned in a primary prevention population; 2) determine the concordance between the 2 methods of detecting subclinical atherosclerosis; and 3) establish which proportion of patients should receive statins according to the initial risk stratification and after being recategorized by screening for risk modulators. Methods: Individuals aged 18 to 79 years who consulted for cardiovascular risk assessment and who were not receiving lipid-lowering treatment were included. The risk score was calculated in each patient using ASCVD Risk Estimator. The presence of CAP, CAC score and Lp(a) level were evaluated. Results: The cohort was made up of 348 patients; mean age was 55.6 ± 12.2 years and 45.4% were men. In the total population, 29.8%, 36.8%, and 53.2% of patients showed Lp(a) value ≥ 50 mg/dL, CAP, or a CAC score > 0, respectively. The prevalence of CAP and CAC score was progressively higher according to the cardiovascular risk category; however, the proportion of low-risk subjects who had risk modulators was considerable (Lp(a) ≥ 50 mg/dl: 25.7%; CAP: 22%; CAC score > 0: 33%). In the 60 subjects <45 years , the prevalence of CAC score > 0 and CAP was 18.3% and 10%, respectively. The agreement between the two methods for quantifying subclinical atheromatosis was fair (kappa= 0.33). The indication for statin treatment increased by 31.6% after evaluating the presence of modulators. Conclusion: The presence of risk modulators was common in this population in primary prevention, even in low-risk subjects or <45 years. Detection of risk modulators could improve initial stratification and lead to reconsideration of statin treatment.

Epicardial Fat Volume Is Associated with Endothelial Dysfunction, but not with Coronary Calcification: From the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

The increase in epicardial fat volume (EFV) is related to coronary artery disease (CAD), independent of visceral or subcutaneous fat. The mechanism underlying this association is unclear. Coronary artery calcium (CAC) score and endothelial dysfunction are related to coronary events, but whether EFV is related to these markers needs further clarification. To evaluate the association between automatically measured EFV, cardiovascular risk factors, CAC, and endothelial function. In 470 participants from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) with measures of EFV, CAC score and endothelial function, we performed multivariable models to evaluate the relation between cardiovascular risk factors and EFV (response variable), and between EFV (explanatory variable) and endothelial function variables or CAC score. Two-sided p <0.05 was considered statistically significant. Mean age was 55 ± 8 years, 52.3% of patients were men. Mean EFV was 111mL (IQ 86-144), and the prevalence of CAC score=0 was 55%. In the multivariable analyses, increased EFV was related to female sex, older age, waist circumference, and triglycerides (p<0.001 for all). Higher EFV was associated with worse endothelial function: as compared with the first quartile, the odds ratio for basal pulse amplitude were (q2=1.22, 95%CI 1.07-1.40; q3=1.50, 95%CI 1.30-1.74; q4=1.50, 95%CI 1.28-1.79) and for peripheral arterial tonometry ratio were (q2=0.87, 95%CI 0.81-0.95; q3=0.86, 95%CI 0.79-0.94; q4=0.80, 95%CI 0.73-0.89), but not with CAC score>0. Higher EFV was associated with impaired endothelial function, but not with CAC. The results suggest that EFV is related to the development of CAD through a pathway different from the CAC pathway, possibly through aggravation of endothelial dysfunction and microvascular disease.

Prevalence, determinants and prognostic value of coronary artery calcium score in asymptomatic patients with diabetes: A systematic review and meta-analysis

Coronary artery calcium score (CACS) is evidenced as one of the most effective markers to refine cardiovascular (CV) risk stratification in general population. However, in asymptomatic patients with diabetes, guidelines present mild recommendations for its use, as its prognostic interest require further evidence, especially in different subsets. Thus, we carried-out a systematic review and meta-analysis to address the prevalence of high CACS, its determinants and prognostic value in asymptomatic patients with diabetes, with a special focus on the evidence on its interest in different sex and ethnic groups. We performed a systematic search in PubMed, Embase and Science Direct for studies presenting original data on CACS, and reporting its prevalence, determinants and prognosis in patients with diabetes. Using random effects models, we calculated pooled odds ratios (OR) for CACS determinants and prognostic value on all-cause mortality and/or fatal and non-fatal CV events in different categories. We included 23 studies. Female sex and black ethnicity presented the lowest prevalence of CACS > 0. Age, male sex, non-black ethnicity and diabetes duration were identified as independent risk factors for high CACS. Among the 10 studies ( n = 110,396 person-years) that assessed the CACS prognosis, 1626 deaths and CV events were analysed. The pooled OR for all-cause death or CV events were 4.03 (95%CI: 3.04-5.34), 5.87 (4.32-7.99) and 9.04 (5.81-14.06) respectively for CACS > 0 vs. CACS = 0, CACS≥ 100 and CACS≥ 400 vs. CACS < 10. In addition, we found that for similar CACS, these OR were greater in women than men. This meta-analysis shows that the increase in CACS is strongly associated with an increased risk for all-cause mortality and/or fatal and non-fatal CV events in asymptomatic patients with diabetes. While men are at greater risk to develop high CACS, the prognostic value of the latter is stronger in women to predict CV events and death.

Coronary calcium score in symptomatic patients referred for a coronary computed tomographic angiography. Influence of diabetes

The benefit of the coronary artery calcium score (CACS) measured by cardiac CT is well documented in asymptomatic patients at intermediate risk, however is not known in symptomatic patients. The coronary CT angiography (CCTA) allows an anatomical evaluation of the coronary arteries. The objective was to determine, in symptomatic patients, with diabetes or not, the predictive value of CACS for the presence of significant coronary stenosis (CS > 50%) detectable by CCTA. The study included 52 patients (36 wemen/16 men), mean age 61 years (35–79 years), including 22 diabetics, who had a CACS measurement and a CCTA with a 64-slice cardiac CT with an atypical chest pain syndrome and without history of ischemic heart disease, revascularization by coronary angioplasty or coronary artery bypass grafting. The patients were divided into 5 groups according to the CACS: 0, 1–10, 11–100, 101–400, > 400 AU. The prevalence of CACS in patients was 65%. The CACS was: 0, 1–10, 11–100, 101–400, > 400 respectively in 18, 14, 5, 8, 8 patients. Fifteen patients (29%) had CS on the CCTA. The percentage of diabetics was somewhat higher among these patients than among the 37 without CS (60% vs. 37%, P = 0.09). CS was present in 2 of 18 patients with CACS = 0, 1/13 with CACS 1–10, 1/5 with CACS 11–100, 3/8 with CACS 101–400, and 8 patients with CACS > 400. Thus the prevalence of CS was 11% and 69% respectively among patients with CACS ≤ 100 or > 100 ( P < 0.001). Among patients with CACS > 100, CS was found in 7 diabetics and 4 of 9 non-diabetics. These data suggest that about 30% of patients with suspected angina have coronary stenosis detectable by CCTA, when a CACS is > 100 its predicts the presence of CS with a positive predictive value of 100% in diabetics (vs. 44% in no diabetics), while CS is present in approximately 10% of patients with CACS < 10, suggesting an atheroma with no or little calcification.

Coronary artery calcium in patients with atrial fibrillation undergoing catheter ablation – an opportunity to personalize cardiovascular and thromboembolic risk management

Abstract Introduction There is a well-established association between atrial fibrillation (AF) and coronary artery disease (CAD). Coronary artery calcium score (CACS) is a helpful tool to refine cardiovascular risk stratification and guide strategies of cardiovascular (CV) primary prevention. Purpose To evaluate the prevalence and clinical implications of CACS in terms of CV and thromboembolic risk stratification and preventive therapies, in patients with AF and atrial flutter (AFL) undergoing catheter ablation. Methods Cross-sectional study including patients with AF/AFL undergoing multidetector computed tomography (MDCT) for ablation procedure planning from 2017 to 2019. Baseline clinical and demographical data were collected. CV and thromboembolic risks were evaluated based on the SCORE (Systematic Coronary Risk Evaluation) system and CHA2DS2-VASc score. CACS was assessed in patients without history of coronary artery disease using the Agatston method. Results A total of 474 patients were included (441 with AF and 33 with AFL, mean age of 58±10 years, 62% male). Excluding those over 70 years of age (n=50, 11%), most patients had low (n=69, 22%) or moderate (n=188, 60%) CV risk and 277 (64%) patients had a CHA2DS2-VASc score ≥1 (male) or ≥2 (female). Overall, 265 patients (65%) were under chronic anticoagulation and 157 (39%) were under statin therapy. CAC was present in 254 (54%) patients and showed a multivessel distribution in 62% of the cases. The left main stem was affected in 81 (17%) patients and the left anterior descending artery in 211 (45%). Incorporating CACS&amp;gt;100 as a variable in CHA2DS2-VASc score (vascular disease parameter in patients without history of vascular disease) would have resulted in a significant score reclassification (n=87, 20%) and identification of new potential candidates for anticoagulation (n=12, 3%). Additional, anticoagulation would be indicated as a class IA recommendation in more 26 (6%) patients. Twenty three percent of patients with zero calcium were taking statins, and only 7% of patients with a CACS &amp;gt;300 were on high-intensity statin therapy. According to the recommendations and based on their CACS and current therapy, 103 (25%) patients would be candidates for statin therapy and 69 (17%) patients would be candidates for changes in the current statin therapy intensity (Table 1). Conclusion In our study, more than half of the patients undergoing MDCT before AF/AFL catheter ablation had coronary calcium above zero. Our findings suggest that an opportunistic evaluation of CACS can be clinically valuable in thromboembolic risk stratification and management of preventive pharmacological strategies such as anticoagulation and statins. Funding Acknowledgement Type of funding sources: None.

Cadmium exposure and coronary artery atherosclerosis

BACKGROUND AND AIM: The general population is ubiquitously exposed to cadmium through the diet and smoking. Cadmium exposure is associated with increased morbidity and mortality in myocardial infarction. Our hypothesis was that this association is due to atherosclerosis, and our aim was to test this by examining associations between cadmium and coronary artery calcification, an established measure of atherosclerosis. METHODS: We based our analysis on the population-based Swedish SCAPIS study, and included 5627 individuals (51% women), aged 50–64 years, enrolled from 2013 to 2018. The coronary artery calcium score (CACS) was obtained from computed tomography. Cadmium in blood (B-Cd) was analyzed by inductively coupled plasma mass spectrometry (ICP-MS). Associations between B-Cd and CACS (Agatston score) were evaluated using prevalence ratios (PRs) in models adjusted for sex, age, smoking, hypertension, diabetes, LDL/HDL ratio, and heredity. RESULTS:The median B-Cd concentration was 0.24 µg/L. The prevalence of positive coronary artery calcification (CACS 0) was 41% and the prevalence of CACS ≥100 was 13%. The prevalence of CACS 0 was slightly increased (PR 1.1, 95% CI 1.0–1.3) in the highest quartile (Q4) of B-Cd (median 0.63 µg/L) with Q1 as reference. For CACS ≥100 the PR was 1.6 (95% CI 1.3–2.0). B-Cd was significantly associated with CACS ≥100 also in never-smokers (PR for Q4 vs. Q1 1.7, 95% CI 1.1 – 2.7), but based on few cases. CONCLUSIONS:Blood cadmium in the highest quartile was associated with CACS in this general population sample with low to moderate cadmium exposure, supporting the hypothesis that atherosclerosis is the main mechanism underlying the associations between cadmium and incident cardiovascular disease. Public health measures to reduce cadmium exposure are warranted. KEYWORDS: Cardiovascular diseases, Chemical exposures, Environmental epidemiology, Food/nutrition, Heavy metals,

Relationships between cardiovascular risk factors and white-coat hypertension diagnosed by home blood pressure recordings in a middle-aged population.

Objective:To study risk in white-coat hypertension (WCH) by measurement of coronary artery calcium score (CACS), carotid--femoral pulse-wave velocity (PWV) and carotid plaques.Methods:Cross-sectional population-based cohort with randomized selection of participants from Linköping, Sweden. An Omron m10-IT oscillometric device was used for clinic and home blood pressures (HBP) in the morning and evening for 1 week.Results:We recruited 5029 middle-aged and mainly defined WCH as SBP at least 140 mmHg and/or DBP at least 90 mmHg with HBP less than 135/85 mmHg. There were 2680 normotensive participants and 648 had WCH after exclusion of treated participants. More women (59.5%) than men (42.8%, P < 0.001) had WCH. We found higher prevalence of CACS greater than 100 compared with less than 100 (12.4 vs. 7.2%, P < 0.001), PWV (11.5 ± 1.5 vs. 10.4 ± 1.3 m/s, P < 0.001) and a higher prevalence of one or more carotid plaques (59.5 vs. 48%, P < 0.001) in participants with WCH than in normotension. Participants with WCH also had more dyslipidemia and higher glucose levels. Normotensive women scored lower on nervousness than women with WCH (P = 0.022). After matching of 639 participants with WCH to normotensive participants according to age, gender and systolic HBP the prevalence of a high CACS (12.1 vs. 8.6%, P = 0.003,) PWV (11.0 ± 0.068 vs. 11.5 ± 0.068 m/s, estimated marginal means ± SE, P < 0.001 by ANOVA) but not more carotid plaques (59.5 vs. 55.6%, P = 0.23), remained in the participants with WCH compared with the matched normotensive participants.Conclusion:WCH is particularly common in middle-aged women, and it displays metabolic dysfunction and increased prevalence of arteriosclerotic manifestations in both genders. As markers of increased cardiovascular risk were present also after matching normotensive and WCH participants according to systolic HBP, age and gender, the presence of WCH signals an increased cardiovascular risk burden that is not fully explained by elevated BP levels at home.

Polyvascular subclinical atherosclerosis in familial hypercholesterolemia: The role of cholesterol burden and gender

Background and aimHeterozygous familial hypercholesterolemia (HeFH) is a genetic disease characterized by a heterogeneous phenotype. The assessment of cardiovascular (CV) risk is challenging for HeFH. Cholesterol burden (CB) allows to estimate the lifelong exposure to high levels of cholesterol. The aim of this study was to analyze the distribution of subclinical atherosclerosis and the relationship between atherosclerosis and the CB in a sample of HeFH patients, focusing on sex-related differences. Methods and Results154 asymptomatic HeFH subjects underwent coronary-artery-calcium score (CACs) and Doppler ultrasound of carotid and femoral arteries. Yearly lipid profiles and HeHF history were obtained from patients' files in order to calculate total CB. Atherosclerotic burden was defined by the presence of CACs > 0 or by the presence of carotid or femoral plaque. Study population was stratified according to gender. The prevalence of CAC, carotid and femoral atherosclerosis was of 62%, 55% and 56%, respectively. Coronary district was the least involved in women, who had a higher prevalence in carotid atherosclerosis. When two vascular districts were affected, women had an increased prevalence of femoral and carotid atherosclerosis whereas men had a higher prevalence of coronary and femoral atherosclerosis. CB correlated to the presence of atherosclerosis in any of the three vascular districts with a significant increasing trend depending on the number of affected areas. ConclusionsA polyvascular atherosclerotic burden is found in asymptomatic HeFH patients. Gender differences in the territory distribution were observed. The early and lasting exposure to high cholesterol, as expressed by CB, is a major determinant of atherosclerotic burden.

Bariatric surgery and the coronary artery calcium score.

to investigate the impact of bariatric surgery on the coronary artery calcium score (CACS), and to establish predictors of progression of this score in patients with obesity. prospective study that evaluated 18 obese patients before and after bariatric surgery. All patients were submitted to computed tomography scans and blood tests (total cholesterol, LDL, HDL, triglycerides, fasting plasma glucose, A1C, insulin, serum calcium, C-peptide and C-Reactive Protein) in order to determine CACS and Framingham risk score (FRS). the FRS decreased 50% between the pre and postoperative evaluations. The mean CACS increased significantly at the late postoperative period, going from 8.5 to 33.1. HDL levels had also increased between the pre and postoperative periods. All of the other quantitative variables reduced significantly at the postoperative evaluation. When dividing CACS into four degrees, it was observed that 22.2% presented CACS=0 at the postoperative evaluation. The prevalence of mild CACS decreased from 77.8% to 50%, while moderate CACS remained the same (11.1%). Severe CACS increased from 11.1% to 16.7%. Older ages were linked to CACS progression, and this was the only variable that presented statistical association with progression. bariatric surgery leads to positive cardiovascular outcomes, apparently regardless of CACS.

Subclinical coronary artery disease in Swiss HIV-positive and HIV-negative persons.

HIV-positive persons have increased cardiovascular event rates but data on the prevalence of subclinical atherosclerosis compared with HIV-negative persons are not uniform. We assessed subclinical atherosclerosis utilizing coronary artery calcium (CAC) scoring and coronary computed tomography angiography (CCTA) in 428 HIV-positive participants of the Swiss HIV Cohort Study and 276 HIV-negative controls concurrently referred for clinically indicated CCTA. We assessed the association of HIV infection, cardiovascular risk profile, and HIV-related factors with subclinical atherosclerosis in univariable and multivariable analyses. HIV-positive participants (median duration of HIV infection, 15 years) were younger than HIV-negative participants (median age 52 vs. 56 years; P < 0.01) but had similar median 10-year Framingham risk scores (9.0% vs. 9.7%; P = 0.40). The prevalence of CAC score >0 (53% vs. 56.2%; P = 0.42) and median CAC scores (47 vs. 47; P = 0.80) were similar, as was the prevalence of any, non-calcified/mixed, and high-risk plaque. In multivariable adjusted analysis, HIV-positive participants had a lower prevalence of calcified plaque than HIV-negative participants [36.9% vs. 48.6%, P < 0.01; adjusted odds ratio (aOR) 0.57; 95% confidence interval (CI) 0.40-0.82; P < 0.01], lower coronary segment severity score (aOR 0.72; 95% CI 0.53-0.99; P = 0.04), and lower segment involvement score (aOR 0.71, 95% CI 0.52-0.97; P = 0.03). Advanced immunosuppression was associated with non-calcified/mixed plaque (aOR 1.97; 95% CI 1.09-3.56; P = 0.02). HIV-positive persons in Switzerland had a similar degree of non-calcified/mixed plaque and high-risk plaque, and may have less calcified coronary plaque, and lower coronary atherosclerosis involvement and severity scores than HIV-negative persons with similar Framingham risk scores.

The Value of Big Endothelin-1 in the Assessment of the Severity of Coronary Artery Calcification

Progression of coronary artery calcification (CAC) was significantly associated with all-cause mortality, and high coronary artery calcium score (CACS) portends a particularly high risk of cardiovascular events. But how often one should rescan is still an unanswered question. Preliminary screening by testing circulating biomarker may be an alternative before repeat computed tomography (CT) scan. The aim of this study was to investigate the value of big endothelin-1 (bigET-1), the precursor of endothelin-1 (ET-1), in predicting the severity of CAC. A total of 428 consecutively patients who performed coronary computed tomography angiography (CCTA) due to chest pain in Fuwai Hospital were included in the study. The clinical characteristics, CACS, and laboratory data were collected, and plasma bigET-1 was detected by enzyme-linked immunosorbent assay (ELISA). The bigET-1 was positively correlated with the CACS (r = .232, P < .001), and the prevalence of CACS >400 increased significantly in the highest bigET-1 tertile than the lowest tertile. Multivariate analysis showed that bigET-1was the independent predictor of the presence of CACS >400 (odds ratio [OR] = 1.721, 95% confidence interval [CI], 1.002-2.956, P = .049). The receiver operating characteristic (ROC) curve analysis showed that the optimal cutoff value of bigET-1 for predicting CACS >400 was 0.38 pmol/L, with a sensitivity of 59% and specificity of 68% (area under curve [AUC] = 0.65, 95% CI, 0.58-0.72, P < .001). The present study demonstrated that the circulating bigET-1 was valuable in the assessment of the severity of CAC.

Abstract 222: Utility of Non-Contrast, Non-EKG Gated Multi-Detector Computed Tomography to Rule Out Obstructive Coronary Artery Disease in Heart Transplant Recipients

Background: Annual or biannual coronary angiography is recommended after heart transplantation. This is associated with radiation and contrast exposure in addition to being invasive. Absence of coronary calcium on CT in non-transplanted patients has a high negative predictive value (NPV) to rule out obstructive CAD. Objective: To determine whether the absence of coronary calcium on non-contrast, non-gated MDCT has a high NPV to rule out obstructive CAD in heart transplant recipients. Methods: We included patients with a non-contrast, non-gated chest CT within 1 year of undergoing a coronary angiogram from 2006 to 2016. Obstructive CAD was defined as stenosis &gt;50%. Coronary artery calcium scores (CACS) were calculated by the Agatston method using the syngo.via platform (Siemens Healthcare GmbH, Germany). For analysis, CACS were categorized based on a) presence or absence of coronary calcium (i.e., CACS=0 or CACS&gt;0) or b) severity of calcification (i.e., CACS=0, CACS 0-100 and CACS&gt;100). Results: We reviewed 76 consecutive angiograms and corresponding CTs. Prevalence of obstructive CAD was 9.2% (n=7). Prevalence of CACS=0 was 89.5% (n=68) of which 5 had obstructive CAD presenting a NPV of 93%. 8 patients had CACS&gt;0 of which 2 had obstructive CAD on angiogram (positive predictive value=25%). CACS was found to correlate with severity of CAD by angiography(p&lt;0.05). Of 7 angiograms with obstructive CAD, stenosis &gt;50% was found in 10 vessels - 5 LAD, 1 D1, 1 LCx, 2 OM branches and 1 RCA. Calculating CACS enabled detection of 1/5 LAD lesions; lesion in D1 was detected as an LAD lesion; lesions in the OM branches and RCA were not detected. Conclusion: Absence of coronary calcium on MDCT has a high NPV in ruling out obstructive CAD in heart transplant recipients. However, only 2/10 obstructive lesions on angiogram had calcification plaques detected on corresponding vessels on CT. The clinical significance of this is yet to be determined.

Prevalence and severity of coronary artery calcification based on the epidemiologic pattern: A propensity matched comparison of asymptomatic Korean and Chinese adults

BackgroundLifestyle, environmental, and genetic factors substantially influence cardiovascular disease (CVD) risk. We aimed to explore epidemiologic trends in coronary artery calcium scores (CACS), as a marker of CVD, along with possible differences by geographic area and study period in separate East Asian populations. MethodsWe generated 3 matched groups (n=702) using a propensity scoring approach derived from a Korean (N=48,901) and Chinese cohort (N=927) as follows: (1) A recent Chinese group and (2) recent Korean group, both of whom underwent CACS scanning from 2012–2014; and (3) a past Korean group who underwent CACS scanning 8–10years before the index group (2002–2006). We used logistic regression to generate odds ratios (OR) with 95% confidence intervals (95% CI) to estimate the likelihood of having CACS between the groups, based on CACS stratified by severity: >0 (any), >100 (moderate), and >400 (severe). ResultsThe prevalence of any, moderate, or severe CACS did not differ significantly between the recent Chinese and Korean groups. Notably, the odds of the presence of moderate CACS in the recent Chinese group (OR: 3.05, 95% CI: 1.49–6.71, P-value<0.001) and the presence of any CACS in the recent Korean group (OR: 1.58, 95% CI: 1.17–2.15, P-value<0.001) were significantly higher than in the past Korean group. ConclusionsIn this study involving separate East Asian populations, there were no geographic differences in the prevalence of CACS. However, changes in other unmeasured factors over time are likely the culprits for the elevated prevalence of CACS in asymptomatic East Asians.

Association of Vitamin D Level and Subclinical Coronary Artery Disease

Background: The role of vitamin D level in subclinical atherosclerosis remains controversial. We aimed to investigate the relationship between vitamin D level and coronary artery calcium score (CACS). Patients methods: We investigated 303 consecutive patients referred to an outpatient clinic for CACS. The 25-hydroxy vitamin D [25(OH) D] levels were checked within three months of CACS evaluation. Vitamin D levels of <30 and <20 ng/mL were used as thresholds of vitamin D insufficiency and deficiency, respectively. The correlation between CACS and vitamin D was assessed. Unadjusted and covariate-adjusted logistic regression analyses were used to predict positive CACS. Results: The mean age in this study is 61.8 ± 11.8 years (39.9% female). The majority of patients enrolled were Caucasian (87.4%). Median (interquartile range) serum 25(OH) D concentration was 30.0 (23.0, 39.0) ng/ml. Vitamin D was insufficient ( 0) was prevalent in 206 (68%) participants. In the unadjusted model, the 25 (OH) D levels were not associated with the prevalence of CACS among all cases or among patients with positive CACS. Logistic regression models, after controlling for risk factors, did not change the results. In addition, among the 206 participants with prevalent CACS, 25 (OH) D levels were not associated with CACS severity. Conclusions: Our single centre retrospective study in a population with low prevalence of vitamin D deficiency failed to find a significant relation between 25(OH) D level and CACS even when adjusted for risk factors.

The association between epicardial fat thickness and coronary artery calcification according to blood pressure status in nonhypertensive individuals: From the CAESAR study

Epicardial adipose tissue represents visceral adiposity, and the coronary artery calcium (CAC) score (CACS) has been suggested as a reasonable surrogate for coronary atherosclerosis. Epicardial fat thickness (EFT) and blood pressure status can be attributed to coronary artery calcification. The present study was performed to evaluate the association between EFT and coronary artery calcification according to blood pressure status in nonhypertensive individuals. The CACS and echocardiographic EFT measurement were performed in a total of 1878 nonhypertensive individuals (1535 men; mean age, 44±8.3years). Subjects were divided into quartiles according to EFT (≤2.575, 2.576-3.168, 3.169-3.900, and >3.900mm) and into 2 groups according to the presence of CAC. Additionally, individuals were classified as normotensive (n=1064) or prehypertensive (n=814). The prevalence of CACS >0 group in prehypertensive individuals was 6.1%, 18.1%, 22.6%, and 29.9% in the lowest, second, third, and highest EFT quartiles, respectively (P<.001) and 7.3%, 13.1%, 14.0%, and 13.9% in the normotensive group (P=.050). On multivariate regression analysis, the second, third, and highest quartile EFT groups had higher odds ratios for the presence of CAC than that of the lowest quartile (odds ratio [95% confidence interval], 3.849 [1.215-12.194], 4.069 [1.235-13.412], and 4.383 [1.385-13.875], respectively), although only in prehypertensive individuals. Moreover, an increased absolute EFT level was also associated with increased CACS in prehypertensive individuals (standardized β=0.101, P=.035). This study showed an independent relationship between EFT and coronary artery calcification in nonhypertensive individuals, with variable differences in this association according to blood pressure status.

The association of rate of weight gain during early adulthood with the prevalence of subclinical coronary artery disease in recently diagnosed type 2 diabetes: the MAXWEL-CAD study.

To investigate the association of the rate of weight gain (Ratemax_wt) between the age of 20 years and the age of maximum lifetime weight gain with indicators of subclinical coronary artery disease (CAD) at the time of diagnosis of type 2 diabetes (T2D). We studied 1,724 consecutive Korean subjects aged ≥30 years with recently diagnosed (within 3 months) T2D and one or more cardiovascular risk factors to investigate the association of Ratemax_wt with subclinical CAD. We used 64-slice cardiac computed tomography angiography to evaluate the degree of coronary artery stenosis, multivessel involvement, plaque characteristics, and coronary artery calcium score (CACS). Body weight at age 20 years (Wt20y) was obtained from participant records. Participants recalled their maximum weight (Wtmax) before T2D diagnosis and age at maximum weight (Agemax_wt). The Ratemax_wt was calculated as (Wtmax - Wt20y) / (Agemax_wt - 20 years). The prevalence of coronary artery stenosis (≥50%), multivessel involvement (two or more vessels), plaque characteristics, and CACS ≥100 were 11.4%, 6.6%, 19.7%, and 12.8%, respectively. Mean Wt20y and Wtmax were 60.1 ± 10.5 and 73.0 ± 11.5 kg, respectively. Mean Agemax_wt was 41.3 ± 10.7 years, and Ratemax_wt was 0.59 ± 0.56 kg/year. After adjusting for cardiovascular risk factors, including current BMI, the highest quarter of prior weight gain was significantly associated with coronary artery stenosis, multivessel involvement, and plaque characteristics, particularly mixed and noncalcified plaque. The findings suggest that a greater rate of prior weight gain may accelerate the development of subclinical vascular complications in patients with newly diagnosed T2D.

Warfarin Use and Prevalence of Coronary Artery Calcification Assessed by Multislice Computed Tomography

Warfarin inhibits the synthesis and function of matrix Gla protein, a vitamin K-dependent protein, which is a potent inhibitor of tissue calcification. We had earlier reported the association of warfarin use with valvular calcification in patients with nonvalvular atrial fibrillation. The aim of our present study was to investigate the association of warfarin use with the presence and severity of coronary artery calcification. A total of 233 patients underwent computed tomography scan (CT) at our institution for the assessment of coronary artery calcium score (CACS). Of 233 patients, the mean age was 63 years, 28 patients (12%) were treated with warfarin, and 205 patients (88%) were not on warfarin. Based on their total CACS, the patients were subsequently stratified into 59 with no coronary calcium (CACS = 0), 63 with low CACS (1-100), 49 with moderate CACS (101-400), 33 with severe CACS (410-1000), and 29 with very severe CACS (>1000). The χ test and Student t-test were used for the comparison of categorical and continuous variables, respectively, between warfarin users and nonusers. Using the variables age, gender, race, smoking, hypertension, diabetes, dyslipidemia, glomerular filtration rate, calcium-phosphorus product, alkaline phosphatase, use of aspirin, beta blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and statins, stepwise logistic regression analysis did not show any association of coronary calcification with use of warfarin. In our study, warfarin use was not associated with a higher prevalence or severity of CACS assessed by coronary computed tomography.

Arterial stiffness, fatty liver and the presence of coronary artery calcium in a large population cohort

BackgroundWe tested whether fatty liver, brachial-ankle pulse wave velocity (baPWV) and conventional cardiovascular risk factors were associated with a coronary artery calcium (CAC) score > 0 (as a marker of the presence of early atherosclerosis) in a cohort of healthy Korean adults.MethodThe study population consisted of individuals who underwent a comprehensive health examination in 2010 at Kangbuk Samsung Hospital, College of Medicine, Sungkyunkwan University in South Korea. The 6009 subjects of total 7371 participants who had an assigned CAC score following coronary computed tomography (CT) scanning and baPWV were analyzed.ResultsAmong the study subjects, 39.2% of the population had evidence of fatty liver by ultrasound and 4.6% of the population had evidence of CAC score > 0. Among individuals with a CAC score = 0, 38% of the individuals had fatty liver compared with 58% of the individuals with a CAC score > 0. The individuals with a CAC score > 0 also had higher blood pressure and had more metabolic abnormalities. The prevalence of CAC score > 0 was increased according to baPWV quartiles and was higher in the fatty liver group in comparison with those without fatty liver. The odds ratio for CAC score > 0, after adjusting for clinical risk factors, showed a significant elevation with increasing quartiles of baPWV and the presence of fatty liver.ConclusionWe showed that both fatty liver and baPWV are independently associated with the presence of CAC, a marker of preclinical atherosclerosis. These associations are independent of conventional risk factors and medical history.

Abstract P157: Ethnic Differences In the Association Between Inflammatory Markers and Cytokines With Coronary Artery Calcium in Postmenopausal Women

Objective: We assessed the association between TNF-a, IL-6, leptin, and adiponectin with coronary artery calcium (CAC) in postmenopausal women without known cardiovascular disease. Methods: Participants were 192 Caucasian (C), 178 Filipina (F) and 181 African-American (AA) with measures of CVD risk factors, inflammatory markers and cytokines in 1995-99 and CAC in 2000-02. Age adjusted geometric means are presented. Results: Caucasians were significantly older, while AA had larger BMI (C:26.0, F: 25.5, AA: 29.7 kg/m 2 , p&lt;0.001) but lower triglycerides (C:132, F: 153, AA: 92 mg/dl, p&lt;0.001). Filipinas had elevated type 2 diabetes (T2DM) (C: 5.7, F: 32.6, AA: 12.2%, p&lt;0.001) and hypertension (HTN) prevalence (C: 45.3, F: 66.3, AA: 46.4%, p&lt;0.001), statin use (C: 19.3, F: 31.5, AA: 16.6%, p=0.002) and visceral adipose tissue (C: 61.6, F:68.7, AA: 57.6 cm3, p&lt;0.001). Filipinas had significantly lower adiponectin levels than either group, while AA women had higher IL-6 levels than either group, and lower adiponectin than Caucasians. No ethnic differences were observed in leptin, TNF-a levels nor prevalence of CAC score of 100 or higher (p=0.10). Caucasian Filipino African-American Age (yrs) 66.7 64.4 * 61.2 † ‡ TNF-a (pg/ml) 1.02 1.10 1.13 IL-6 (pg/ml) 1.46 1.54 2.08 † ‡ Adiponectin (ug/ml) 12.61 6.15 * ‡ 8.07 † Leptin (ng/ml) 14.24 14.09 15.71 CAC &gt;=100 after 5 yrs 27.1% 29.8% 23.8% p&lt;0.05, * F vs C, † AA vs C, ‡ AA vs F Multivariable regression showed older age (adjusted OR: 1.08, 95% CI:1.15-1.12), log IL-6 (adj OR: 1.69 (1.20 - 2.40)), HTN (adj OR: 1.79 (1.16-2.76)), T2DM (adj OR: 1.85 (1.09- 3.14)), and current statin use (adj OR: 1.99 (1.24-3.18) were independently associated with CAC&gt;=100, after adjusting for VAT, adiponectin, leptin, TNF-a, HDL-c and estrogen use. When stratified by ethnicity, CAC&gt;=100 was associated with older age (adj OR: 1.19 (1.11- 1.27)) and log IL-6 (adj OR: 3.82 (1.71- 8.52)) in Caucasians; older age (adj OR: 1.08 (1.03- 1.14)), log IL-6 (adj OR: 1.79 (1.02- 3.16)), and HTN (adj OR: 3.74 (1.70- 8.257)) among AA; and HTN (adj OR: 2.62 (1.13- 6.04)) and statin use (adj OR: 2.22 (1.08- 4.57)) among Filipinas. Conclusion: IL-6 was associated with CAC&gt;=100 among Caucasian and African-American women, but not among Filipinas. Funding(This research has received full or partial funding support from the American Heart Association, National Center)