Prevalence Of Coronary Artery Calcification Research Articles

Relationship between the triglyceride glucose index and coronary artery calcification in Korean adults

BackgroundThe triglyceride glucose (TyG) index has been considered a simple surrogate marker of insulin resistance. However, few studies have investigated the relationship between the TyG index and coronary artery calcification (CAC). Thus, we investigated the relationship between the TyG index and CAC in healthy Korean adults.MethodsIn total, 4319 participants who underwent cardiac computed tomography (CT) in a health promotion center were enrolled. Anthropometric profiles and multiple cardiovascular risk factors were measured. The TyG index was calculated as ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2], and the insulin resistance index of homeostasis model assessment (HOMA-IR) was estimated. The CAC was measured using multidetector CT, and CAC presence was defined as an Agatston score of >0.ResultsAll subjects were stratified into four groups based on their TyG indices. Significant differences were observed in cardiovascular parameters among the groups, and the prevalence of CAC significantly increased with increasing TyG index. In the logistic regression analysis after adjustment for multiple risk factors, the odds ratio for the prevalence of CAC, when comparing the highest and lowest quartiles of the TyG index was 1.95 (95% CI 1.23–3.11; P for trend = 0.01); the odds ratio for the prevalence of CAC, when comparing the highest and lowest quartiles of HOMA-IR was 1.64 (95% CI 1.12–2.40; P for trend = 0.04). In the receiver operating characteristics analysis, the TyG index was superior to HOMA-IR in predicting CAC.ConclusionThe TyG index is more independently associated with the presence of coronary artery atherosclerosis than is HOMA-IR in healthy Korean adults.

The association of epicardial fat volume with coronary characteristics and clinical outcome.

Recent studies have demonstrated the relationship between epicardial fat volume (EFV) and coronary atherosclerosis, but their association is modest at best. Our purpose is to elucidate the association of epicardial fat with coronary characteristics and clinical outcome. We performed coronary computed tomographic angiography in 651 patients and divided them into three groups according to tertiles of EFV; low-tertile (n = 215), 36-123 ml; middle-tertile (n = 218), 124-165 ml; high-tertile (n = 218), 166-489 ml. The prevalence of coronary calcium score (CCS) >0 (71.6, 73.4, and 83.9% in low-, middle-, and high-tertile group, respectively) and CCS >100 (39.1, 39.9, and 59.2% in each group) was significantly higher in patients with high-tertile EFV compared to the other two groups (p = 0.0047 and p < 0.0001, respectively). The prevalence of CCS >400 was 17.2, 25.7, and 33.1% in each group, which increased stepwise as EFV increased. The significant stenosis (36.2 vs. 27.0%, p = 0.0383), total coronary occlusion (5.5 vs. 0.9%, p = 0.0156), and high-risk plaque (11.0 vs. 5.6%, p = 0.0368) were more prevalent in patients with high-tertile EFV compared to those with low-tertile EFV. The combined rate of cardiac death and myocardial infarction was 0.9, 2.3, and 6.4% in each patient group, respectively, which was significantly higher in patients with high-tertile EFV compared to those with low-tertile EFV (p = 0.0004). The prevalence of coronary artery calcium, significant stenosis, and high-risk plaque increased sharply in patients with high EFV, which was associated with higher rate of cardiac death and myocardial infarction. Thus, high EFV was associated with advanced coronary atherosclerosis and poor prognosis.

Coronary Artery Calcium Volume and Density: Potential Interactions and Overall Predictive Value: The Multi-Ethnic Study of Atherosclerosis

ObjectivesThis study sought to determine the possibility of interactions between coronary artery calcium (CAC) volume or CAC density with each other, and with age, sex, ethnicity, the new atherosclerotic cardiovascular disease (ASCVD) risk score, diabetes status, and renal function by estimated glomerular filtration rate, and, using differing CAC scores, to determine the improvement over the ASCVD risk score in risk prediction and reclassification. BackgroundIn MESA (Multi-Ethnic Study of Atherosclerosis), CAC volume was positively and CAC density inversely associated with cardiovascular disease (CVD) events. MethodsA total of 3,398 MESA participants free of clinical CVD but with prevalent CAC at baseline were followed for incident CVD events. ResultsDuring a median 11.0 years of follow-up, there were 390 CVD events, 264 of which were coronary heart disease (CHD). With each SD increase of ln CAC volume (1.62), risk of CHD increased 73% (p < 0.001) and risk of CVD increased 61% (p < 0.001). Conversely, each SD increase of CAC density (0.69) was associated with 28% lower risk of CHD (p < 0.001) and 25% lower risk of CVD (p < 0.001). CAC density was inversely associated with risk at all levels of CAC volume (i.e., no interaction was present). In multivariable Cox models, significant interactions were present for CAC volume with age and ASCVD risk score for both CHD and CVD, and CAC density with ASCVD risk score for CVD. Hazard ratios were generally stronger in the lower risk groups. Receiver-operating characteristic area under the curve and Net Reclassification Index analyses showed better prediction by CAC volume than by Agatston, and the addition of CAC density to CAC volume further significantly improved prediction. ConclusionsThe inverse association between CAC density and incident CHD and CVD events is robust across strata of other CVD risk factors. Added to the ASCVD risk score, CAC volume and density provided the strongest prediction for CHD and CVD events, and the highest correct reclassification.

CT-Detected Growth of Coronary Artery Calcification in Asymptomatic Middle-Aged Subjects and Association With 15 Biomarkers

ObjectivesThis study sought to determine the incidence and progression of coronary artery calcification (CAC) in asymptomatic middle-aged subjects and to evaluate the value of a broad panel of biomarkers in the prediction of CAC growth. BackgroundCAC continues to be a major risk factor, but the value of biochemical markers in predicting CAC incidence and progression remains unresolved. MethodsAt baseline, 1,227 men and women underwent traditional risk assessment and a computed tomography (CT) scan to determine the CAC score. Biomarkers of calcium-phosphate metabolism (calcium, phosphate, vitamin D3, parathyroid hormone, osteoprotegerin), lipid metabolism (triglyceride, high- and low-density lipoprotein, total cholesterol), inflammation (C-reactive protein, soluble urokinase-type plasminogen activator receptor), kidney function (creatinine, cystatin C, urate), and myocardial necrosis (cardiac troponin I) were analyzed. A second CT scan was scheduled after 5 years. General linear models were performed to examine the association between biomarkers and ΔCAC score, and additionally, sensitivity analyses were performed in terms of binary and ordinal logistic regressions. ResultsA total of 1,006 participants underwent a CT scan after 5 years. Among the 562 participants with a baseline CAC score of 0, 189 (34%) had incident CAC, whereas 214 (48%) of the 444 participants with baseline CAC score >0 had significant progression (>15% annual increase in CAC score). In the multivariate models (n = 1,006), age, sex, hypertension, diabetes, dyslipidemia, and smoking were associated with ΔCAC, whereas the strongest predictor was baseline CAC score. Low-density lipoprotein and total cholesterol levels were independently associated with CAC incidence (n = 562; incidence rate ratio [IRR]: 1.47; 95% confidence interval [CI]: 1.05 to 2.05; and IRR: 1.34; 95% CI: 1.01 to 1.77, respectively), whereas phosphate level was associated with CAC progression (n = 444; IRR: 3.60; 95% CI: 1.42 to 9.11). ConclusionsIn this prospective study, a large part of participants had incident CAC or progression of prevalent CAC at 5 years of follow-up. Low-density lipoprotein and total cholesterol were associated with CAC incidence and phosphate with CAC progression, whereas 12 other biomarkers had little value.

Adult Height, Prevalent Coronary Artery Calcium Score, and Incident Cardiovascular Disease Outcomes in a Multiethnic Cohort.

We assessed the relationships among adult height, coronary artery calcium (CAC) score, incident atherosclerotic cardiovascular disease (ASCVD) events, and atrial fibrillation (AFib) in a multiethnic cohort. We used race/ethnicity-specific height (dichotomized by median value and in quartiles) as the predictor variable within the 4 racial/ethnic groups in the Multi-Ethnic Study of Atherosclerosis (n = 6,814). After a mean of 10.2 years of follow-up (2000-2012), 556 ASCVD events (8.2%) and 539 AFib events (7.9%) occurred. Adult height was not associated with prevalent CAC score (ln(CAC + 1) or categories). Tall stature (i.e., race/ethnicity-specific height ≥median) had a significant but opposite association with future ASCVD and AFib (hazard ratios were 0.72 (95% confidence interval: 0.56, 0.92) and 1.38 (95% confidence interval: 1.07, 1.79), respectively). We observed a gradient-response but opposite association between quartiles of race/ethnicity-specific height and ASCVD/AFib events in our multivariable models. A formal test of interaction between race/ethnicity-specific height and sex was not significant in the ASCVD model (P = 0.78) but was significant in the AFib model (P = 0.03). Tall stature was associated (in a gradient-response fashion) with reduced risk of ASCVD events and increased risk of AFib. Adult height may signal interactions between genetic and environmental factors and may provide risk information independent of current traditional risk factors and CAC score.

Prevalence of coronary artery calcification in Japanese patients with psoriasis: A close correlation with bilateral diagonal earlobe creases.

Psoriasis is a multifactorial inflammatory disorder, in which the inflammation affects not only the skin but also the other internal organs, and can induce cardiovascular and cerebrovascular involvements. However, few predictive factors of cardiovascular diseases have been clarified in patients with psoriasis. This study was performed to verify whether diagonal earlobe creases (ELC) can reflect the hidden comorbidities in Japanese psoriatic patients. Prevalence and subtypes of ELC were analyzed in patients with psoriatic and with non-psoriatic skin diseases, and the correlation with coronary artery calcification (CAC) or fatty liver (FL) detected by computed tomography. Prevalence of CAC was approximately twice higher than data of a Japanese resident-based study previously reported. Generally, prevalence of ELC in a psoriatic group and mean age of psoriatic groups accompanied by ELC were higher and younger than those of a non-psoriatic skin disease group, respectively. Statistically significant differences were detected in the mean age of total or male subjects accompanied by bilateral ELC with complete and incomplete length. Bilateralism of ELC was closely correlated with prevalence of CAC and CAC on multiple branches in psoriatic patients (P = 6.6e-6 and odds ratio [OR] = 14.1, P = 0.00884 and OR = 10.7, respectively), but not with that of FL. On the contrary, body mass index of more than 25 was closely correlated with prevalence of FL, but not that of CAC. Comorbidities of psoriatic patients are frequently unnoticed. ELC, an apparatus-related feature, can be a useful predictive factor for hidden coronary artery involvements in psoriatic patients.

Exercise Cardiac Power And Coronary Artery Calcification In Men

PURPOSE: Low exercise cardiac power (ECP), defined as a ratio of peak oxygen consumption with peak systolic blood pressure during exercise, is associated with adverse cardiovascular events, but the underlying mechanisms remain unclear. Coronary artery calcification (CAC) as a surrogate marker of atherosclerosis is associated with an increased risk of cardiovascular outcomes. We tested the hypothesis that lower levels of ECP may be associated with the prevalence of CAC, independent of conventional risk factors, in a cross-sectional study of 2165 (age 53±6 yrs, range 40-78 yrs) men. METHODS: We measured CAC using multidetector computed tomography using the Agatston coronary artery calcium score. The prevalence of CAC was defined as dichotomous variables of CAC score >0. ECP was calculated by a ratio of peak oxygen consumption with peak systolic blood pressure and classified into quartiles. RESULTS: The presence of CAC was inversely associated with ECP quartiles (both, P < .001 for trend). After adjusting for age, BMI, SBP, HDL-C, hsCRP, glucose, heart rate, smoking, hypertension and diabetes, men in the lowest quartile of ECP had a significantly elevated odds ratios for having CAC (odds ratio (OR) 1.43, 95% CI 1.06-1.93), compared with men in the highest quartile of ECP. Each ECP unit increment as a continuous variable was associated with 4% (OR 0.96, 95% CI 0.93-0.99) lower prevalence of CAC after adjusting for established risk factors. CONCLUSIONS: Our findings demonstrate that lower levels of ECP are associated with the prevalence of coronary artery calcification, which could contribute to increased risk of cardiovascular events.

Relationship Between Lifelong Exercise Volume and Coronary Atherosclerosis in Athletes.

Higher levels of physical activity are associated with a lower risk of cardiovascular events. Nevertheless, there is debate on the dose-response relationship of exercise and cardiovascular disease outcomes and whether high volumes of exercise may accelerate coronary atherosclerosis. We aimed to determine the relationship between lifelong exercise volumes and coronary atherosclerosis. Middle-aged men engaged in competitive or recreational leisure sports underwent a noncontrast and contrast-enhanced computed tomography scan to assess coronary artery calcification (CAC) and plaque characteristics. Participants reported lifelong exercise history patterns. Exercise volumes were multiplied by metabolic equivalent of task (MET) scores to calculate MET-minutes per week. Participants' activity was categorized as <1000, 1000 to 2000, or >2000 MET-min/wk. A total of 284 men (age, 55±7 years) were included. CAC was present in 150 of 284 participants (53%) with a median CAC score of 35.8 (interquartile range, 9.3-145.8). Athletes with a lifelong exercise volume >2000 MET-min/wk (n=75) had a significantly higher CAC score (9.4 [interquartile range, 0-60.9] versus 0 [interquartile range, 0-43.5]; P=0.02) and prevalence of CAC (68%; adjusted odds ratio [ORadjusted]=3.2; 95% confidence interval [CI], 1.6-6.6) and plaque (77%; ORadjusted=3.3; 95% CI, 1.6-7.1) compared with <1000 MET-min/wk (n=88; 43% and 56%, respectively). Very vigorous intensity exercise (≥9 MET) was associated with CAC (ORadjusted=1.47; 95% CI, 1.14-1.91) and plaque (ORadjusted=1.56; 95% CI, 1.17-2.08). Among participants with CAC>0, there was no difference in CAC score (P=0.20), area (P=0.21), density (P=0.25), and regions of interest (P=0.20) across exercise volume groups. Among participants with plaque, the most active group (>2000 MET-min/wk) had a lower prevalence of mixed plaques (48% versus 69%; ORadjusted=0.35; 95% CI, 0.15-0.85) and more often had only calcified plaques (38% versus 16%; ORadjusted=3.57; 95% CI, 1.28-9.97) compared with the least active group (<1000 MET-min/wk). Participants in the >2000 MET-min/wk group had a higher prevalence of CAC and atherosclerotic plaques. The most active group, however, had a more benign composition of plaques, with fewer mixed plaques and more often only calcified plaques. These observations may explain the increased longevity typical of endurance athletes despite the presence of more coronary atherosclerotic plaque in the most active participants.

Early coronary calcifications are related to cholesterol burden in heterozygous familial hypercholesterolemia

The identification of high-risk patients with heterozygous familial hypercholesterolemia (HeFH) that may benefit from early treatment is challenging. Coronary Artery Calcification (CAC) score accounts for coronary atherosclerotic burden. It has proven its accuracy in cardiovascular risk assessment in the general population but data in HeFH are lacking. The aim of our study was to assess CAC prevalence and its relationship with lifelong cholesterol exposure, calculated by total cholesterol burden (TCB) in patients with HeFH. A total of 112 HeFH patients (50% males, median age 45years) regularly followed-up since diagnosis were prospectively recruited at Pitié-Salpêtrière Hospital, Paris, France. CAC score was assessed using noncontrast multi-detector computed tomography. TCB was calculated as total cholesterol (TC) × age at diagnosis plus annually assessed TC. The prevalence of CAC was 58%. Patients without CAC showed lower TCB than patients with CAC (298±110 vs 417.9±89 mmol-years/L, P<.001). Among patients aged <45years (n=56), 39% exhibited CAC and a higher TCB compared with patients without CAC (352±71 vs 255±88 mmol-years/L, P<.001) due to higher TC levels at diagnosis (10.2±2 vs 8.7±2mmol/L, P=.01). Multivariate analysis indicated that TCB was independently associated to CAC. Asymptomatic HeFH subjects exhibit early coronary atherosclerosis directly associated with TCB burden. CAC score may be useful to identify higher risk HeFH patients who can benefit from earlier and more aggressive treatment.

Relationship between cardiac calcification and left ventricular hypertrophy in patients with chronic kidney disease at hemodialysis initiation.

Coronary artery calcification (CAC), cardiac valve calcification (CVC) and left ventricular hypertrophy (LVH) are frequently observed in chronic kidney disease (CKD) patients. These abnormalities significantly affect morbidity and mortality. The aim of this study was to investigate the relationship between CAC, CVC and LVH in CKD patients. This study included 96 patients who were hospitalized and initiated hemodialysis between December 2011 and July 2014 at our five institutions. Multi-detector computed tomography for the quantification of CAC using the Agatston score and transthoracic echocardiography for assessing CVC and LVH were performed for all patients included in the study. We semi-quantitatively evaluated the severity of CVC as a valvular calcification score. We also assessed the presence of LVH in patients with CAC and/or CVC. Among the 96 patients, the prevalence of CAC was 81.3% and CVC was 65.0%. The severity of CAC was closely and significantly associated with that of CVC. The percentage of patients with LVH was the greatest in those with both severe CAC and CVC. CAC was significantly more severe in patients with concentric hypertrophy compared to those with normal geometry. At the initiation of hemodialysis, most CKD patients had CAC, CVC and LVH. In addition, cardiac calcification was significantly associated with LVH in these patients.

Abstract MP069: Dietary Factors Associated with Cardiovascular Outcomes: 25 Year Findings from the Coronary Artery Risk Development in Young Adults (CARDIA) Study

Background: Recommendations to prevent risk of atherosclerotic cardiovascular disease (ASCVD) include reduced intakes of saturated fat, excess sodium and added sugars. Coronary artery calcium (CAC) develops over many years and is a strong predictor of future ASCVD but data regarding diet and CAC are limited. Methods: Participants from CARDIA with Y25 CAC measurement were included (n= 3,121). CAC presence (Agatston score &gt;0) and incident ASCVD including coronary heart disease (CHD), heart failure (HF) and stroke were assessed from baseline (ages 18-30 y) over a 25 y follow up along with baseline diet assessed by diet history. Results: Mean (SD) age at baseline was 25.1 (3.6) y; 56.7% female, 46.7% black. Prevalence of CAC at Y25 was 28.4% and more likely male (64.7 % vs 34.8%) and white (58.7% vs 51.1%). There were 53 (3.0%) and 75 (5.7%) cases of ASCVD events in women and men respectively over 28.4 y (median: 27.1 y). Intake of saturated fat was not, but added sugars were associated with CAC presence. Intake of butter was seemingly protective for both CAC and ASCVD while sugar-sweetened beverages (SSBs) and sodium (borderline) were associated with incident ASCVD. SSBs were specifically associated with CHD, stroke, and HF. Conclusions: Dietary factors play an important role in development of ASCVD, but the same dietary factors may not necessarily be associated with CAC development. Adverse synergistic effects of sodium and added sugars may be especially related to CVD. Whether source of SFA e.g. meat/processed meat, vs dairy foods confers different ASCVD risks and whether added sugars directly or indirectly in SSB’s increase CAC and a CVD event, especially combined with high sodium intake, need further consideration.

Abstract MP079: Coronary Artery Calcium Incidence and Progression Among South Asians: Results From the MASALA Study

Background: South Asians have a high burden of cardiovascular disease. We have reported that South Asians have similarly high prevalence of coronary artery calcium (CAC) compared to non-Hispanic Whites, and higher CAC than other U.S. ethnic minority groups. No studies have determined the incidence or progression of CAC among South Asians. Methods: We used data from a community-based cohort of South Asians (MASALA) and calculated change in CAC Agatston score between Exam 1 (2010-2013) and Exam 2 (2015-2016) among 379 South Asians. We calculated the average annual incident CAC for those with no CAC at Exam 1, and CAC progression among those with CAC at Exam 1. We compared these findings to the previously reported CAC incidence and progression in the Multi-Ethnic Study of Atherosclerosis (MESA). We also determined factors associated with a ≥100 change in CAC score. Results: We used data from 240 men and 139 women with repeat CAC measured after 4.5±0.7 years of follow-up. Among those with no detectable CAC at baseline, 6.8% developed incident CAC annually (9.2% of men and 4.4% of women), which was similar to MESA race/ethnic groups. Among those with known CAC at baseline, the median annual CAC progression was 23 (interquartile range, 8-56). The table shows the distribution of annual CAC progression. South Asians overall, but particularly South Asian men, had significantly higher annual CAC progression compared to the reported average in MESA (overall median 18, 4-53). Established risk factors (age, male sex, diabetes and hypertension), pericardial fat volume and visceral fat area were associated with greater CAC progression. Conclusions: These preliminary results suggest that South Asian men have significantly greater CAC progression compared to other race/ethnic groups. Longer follow-up of MASALA will determine whether CAC score or CAC progression are important predictors of cardiovascular disease events.

Abstract P373: Higher Plaque Volume but Not Density of Coronary Artery Calcium is Associated With Left Ventricular Mass

Coronary artery calcium (CAC) predicts future cardiovascular disease (CVD) events, including heart failure (HF), improves risk stratification beyond traditional CVD risk factors, and is associated with a higher left ventricular mass (LVM), a HF risk factor. Recent findings from the MESA have shown that for a given CAC volume, higher CAC density was inversely associated with incident CVD. It remains uncertain whether CAC volume and density associate differently with LVM. In a multi-ethnic cohort of community dwelling individuals free from clinical CVD at recruitment, we determined the independent cross-sectional associations of baseline CAC volume and density, measured by non-contrast cardiac CT, with LVM, measured by MRI. In 2432 participants with prevalent CAC (density can only be assessed in those with CAC &gt; 0), the mean age was 66 ± 10 years, 59% were men, 50% were European-, 22% were African-, 20% were Hispanic-, and 13% were Chinese-Americans. Median (25-75 th ) CAC volume was 78 (23-259) mm 3 , mean CAC density was 2.7 ± 0.7, and mean LVM was 151 ± 41 grams. CAC density and natural log ( ln ) CAC volume were correlated (correlation coefficient=0.60, P-value &lt; 0.01). Multivariable linear regression models investigated associations of ln (CAC volume) and CAC density with LVM. Model 1 adjusted for demographics (age, sex, and ethnicity) and body surface area. Model 2 included Model 1 plus CVD risk factors (smoking status, fasting glucose, total and HDL cholesterol, systolic blood pressure, and use of medications for hypertension, diabetes, and abnormal lipids). In fully adjusted models one log unit increase in CAC volume as associated with 1.7 gram increase in LVM (Beta = 1.7, 95% CI: 0.7 to 2.6, P &lt; 0.01). In contrast, a unit increase in CAC density was associated with 1.9 gram decrease in LVM (Beta = -1.9, 95% CI: -3.9 to 0.1, P = 0.07). Higher CAC volume, but not CAC density, was cross-sectionally associated with higher LVM; a risk factor for HF. Higher calcium density of coronary artery plaques may not be a hazard for ischemic heart disease mediated increase in LVM. Future studies should determine independent associations of CAC volume and density with incident HF.

Abstract P347: The Relationship Between Renal Artery Calcium and Kidney Function: the Multi-Ethnic Study of Atherosclerosis

Background: Renal Artery Calcium (RAC) has been shown to be associated with a higher odds of hypertension (HTN). The purpose of this study was to determine if the presence and extent of RAC is associated with significant differences in several measures of kidney function. Methods: We analyzed cross-sectional data from the Multi-Ethnic Study of Atherosclerosis (MESA). During MESA follow-up visits 2 and 3, a random subsample of 1226 participants underwent computed tomography (CT) of the abdomen and also had venous blood samples assayed for kidney function. RAC was the primary predictor variable and the following measures of kidney function were the outcome variables: eGFR, cystatin-C, micro and macroalbuminuria and CKD stage. CKD stage was divided into the following groups: stage 1 GFR &lt; 90mL/min, stage 2 GFR 60-89 mL/min, stage 3A GFR 45-59 mL/min, and stage 3B GFR 30-44 mL/min. There were no study participants in the stage 4 category of GFR &lt; 30mL/min. The analyses were adjusted for age, gender, race, height, visceral fat, dyslipidemia, diabetes, cigarette smoking, hypertension, interleukin-6 (IL-6), coronary artery calcium (CAC), abdominal aortic calcium (AAC), renin and aldosterone. Findings: The average age of this cohort was 66.1 years (SD 9.7) and 44.8% (549 of 1226) were male, 36.3% (445 of 1226) Caucasian, 14.1% (173 of 1226) Chinese-American, 21.6% (265 of 1226) African-American and 28.0% (343 of 1226) Hispanic-American. Compared with those with no RAC, those with RAC &gt; 0 were significantly older but not different by gender or race. After adjustment for age, sex and race, those with RAC &gt; 0 had significantly higher visceral fat, were more likely to have dyslipidemia, diabetes and hypertension, had a higher IL6, and a higher prevalence of CAC and AAC &gt; 0. In fully adjusted multivariable linear regression models, the presence of RAC was associated with higher creatinine (β = 0.052, p = 0.01) and Cystatin-C (β = 0.052, p &lt; 0.01), as well as a lower eGFR (β = -2.209, p = 0.06). In logistic regression, the presence of RAC was also associated with albuminuria but after adjustment for cardiovascular risk factors including dyslipidemia, diabetes, smoking and hypertension, this association was no longer significant. In fully adjusted ordinal logistic regression, RAC as a continuous variable was associated with increased odds of being in a higher CKD category (β = 1.14, p = 0.05). Discussion: Our results suggest a modest relationship between RAC and kidney function, when measured by creatinine, Cystatin-C, eGFR and CKD stage. As such, the identification of RAC on abdominal CT scans obtained as part of clinical practice may be considered in the prevention of chronic kidney disease.

High prevalence of coronary artery calcification in Saudi patients with normal myocardial perfusion.

BACKGROUNDNormal single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) has a high negative predictive value for ischemic heart disease. Thus, the presence of subclinical coronary atherosclerosis detected by coronary artery calcification (CAC) score in patients who have undergone SPECT MPI is unknown.OBJECTIVESDetermine the prevalence of coronary artery calcification (CAC) in patients with normal SPECT MPI and examine the association of CAC with conventional coronary artery disease (CAD) risk factors.DESIGNCross-sectional analytical study using medical records from February 2010 to April 2016.SETTINGSSingle tertiary-care center.PATIENTS AND METHODSWe studied patients referred from the outpatient clinical services for clinically indicated noninvasive CAD diagnosis with MPI SPECT. CAC scoring was subsequently performed within 3 months after a normal MPI. We excluded patients with chest pain or decompensated heart failure or patients with a history of CAD. The study population was divided into three groups: patients with a CAC score of 0, a CAC score from 1 to 300, and a CAC score more than 300. The groups were analyzed by age and other demographic and clinical characteristics.MAIN OUTCOME MEASURE(S)Prevalence of CAC in patients with normal MPI.RESULTSThe prevalence of CAC was 55% (n=114) in 207 patients with a mean (SD) age of 57.1 (10.4) years. Twelve percent had severe coronary atherosclerosis (CAC score >300). All patients had a normal MPI SPECT. CAC scores were 0 for 93 patients (45%), 1 to 300 for 89 (43%), and more than 300 for 24 (12%). There was a strong association between CAC score and age (P<.0001), male sex (P<.0001), and diabetes mellitus (P=.042), but no association between CAC score and hypertension (P=.153), family history of CAD (P=.23), obesity (P=.31), hypercholesterolemia (P=.071), or smoking (P=.308).CONCLUSIONSThe prevalence of CAC is high in this study population of patients with normal SPECT MPI. Age, male sex and diabetes were risk factors associated with CAC.LIMITATIONSSingle center and small study population.

UNDERUTILIZATION OF STATIN THERAPY AMONG PARTICIPANTS IN A LUNG CANCER SCREENING PROGRAM WITH A HIGH INCIDENCE OF CARDIOVASCULAR EVENTS

Background : Patients eligible for lung cancer screening (LCS) have an increased risk of cardiovascular disease (CVD). Coronary artery calcium (CAC) scoring is incidentally obtained during LCS. Whether CAC reporting affects statin prescribing is unclear. We assessed CAC prevalence, statin

Sleep-apnea risk and subclinical atherosclerosis in early-middle-aged retired National Football League players.

PurposeLimited data from former National Football League (NFL) players suggest that obstructive sleep apnea (OSA) may be highly prevalent after retirement. It remains unclear whether the high prevalence of OSA in retired players is comparable to nonathletes. This retrospective analysis compared sleep apnea (SA) risk in retired NFL players to a community cohort (CARDIA Sleep study), and examined associations between SA risk and cardiovascular risk factors, including subclinical atherosclerosis.Materials and methodsRetired NFL players (n=122) were matched to CARDIA Sleep participants by age ±2 years (range 37–55 years), body mass index ±2 kg/m2, race, and male sex. Participants underwent electron-beam computed tomography to measure coronary artery calcium (CAC) and completed the Berlin Questionnaire to determine SA risk. The presence of CAC was defined as an Agatston score >0.ResultsRetired NFL players had a greater prevalence of high SA risk than the matched CARDIA Sleep participants (27% vs 11.5%, P=0.002). Compared to the CARDIA Sleep participants, retired players were less likely to smoke, and had higher blood pressure, lower fasting glucose levels, and higher cholesterol levels. However, there was no difference in the prevalence of detectable CAC (30% vs 30%, P=1). In both players and the community cohort, SA risk was not significantly associated with CAC after controlling for age, race, and body mass index.ConclusionRetired NFL players have a greater prevalence of high SA risk but similar prevalence of CAC compared with a well-matched community cohort.

Significant inverse association of equol-producer status with coronary artery calcification but not dietary isoflavones in healthy Japanese men.

Equol, a metabolite of the dietary isoflavone daidzein, is produced by the action of gut bacteria in some individuals who are termed as equol-producers. It is proposed to have stronger atheroprotective properties than dietary isoflavones. We examined a cross-sectional association of dietary isoflavones and equol-producer status with coronary artery calcification (CAC), a biomarker of coronary atherosclerosis, among men in Japan. A population-based sample of 272 Japanese men aged 40-49 years recruited from 2004 to 2007 was examined for serum isoflavones, serum equol, CAC and other factors. Equol-producers were classified as individuals having a serum level of equol >83 nm. The presence of CAC was defined as a coronary Ca score ≥10 Agatston units. The associations of dietary isoflavones and equol-producers with CAC were analysed using multiple logistic regression. The median of dietary isoflavones, equol and CAC were 512·7 (interquartile range (IQR) 194·1, 1170·0), 9·1 (IQR 0·10, 33·1) and 0·0 (IQR 0·0, 1·0) nm, respectively. Prevalence of CAC and equol-producers was 9·6 and 16·0 %, respectively. Dietary isoflavones were not significantly associated with CAC. After multivariable adjustment, the OR for the presence of CAC in equol-producers compared with equol non-producers was 0·10 (95 % CI 0·01, 0·90, P<0·04). Equol-producers had significantly lower CAC than equol non-producers, but there was no significant association between dietary isoflavones and CAC, suggesting that equol may be a key factor for atheroprotective properties of isoflavones in Japanese men. This finding must be confirmed in larger studies or clinical trials of equol that is now available as a dietary supplement.

Prevalence and extent of coronary artery calcification in an asymptomatic cardiovascular Mexican population: Genetics of Atherosclerotic Disease study

The prevalence of coronary artery calcification (CAC), a specific marker of atherosclerosis, is unknown in Mexico. Our aim was to investigate the prevalence and quantity of CAC and their association with cardiovascular risk factors in a Mexican population. CAC was measured by multidetector computed tomography in asymptomatic subjects who participated in the Genetics of Atherosclerotic Disease study. Cardiovascular risk factors and medication were recorded. The sample included 1,423 individuals (49.5% men), aged 53.7±8.4 years. Those with CAC showed a higher prevalence of dyslipidaemia, diabetes, hypertension, and other risk factors. The prevalence of CAC>0 Agatston units was significantly higher among men (40%) than among women (13%). Mean values of CAC score increased consistently with increasing age and were higher in men than women in each age group. Age and high low density lipoprotein cholesterol were independently associated with prevalence of CAC>0 in men and women, while increasing systolic blood pressure in women and age in both genders showed an independent association with CAC extension. In the Mexican population the prevalence and extent of CAC were much higher in men than in women, and strongly increased with age. Independent predictors of CAC prevalence were age and low density lipoprotein cholesterol (LDL-C).

Coffee consumption and calcified atherosclerotic plaques in the coronary arteries: The NHLBI Family Heart Study

While a recent meta-analysis of prospective studies reported that coffee consumption is associated with a lower risk of cardiovascular disease mortality, limited and inconsistent data are available on the relation of coffee intake with subclinical disease. Thus, the aim of the present study was to see the association of coffee consumption with the prevalence of atherosclerotic plaque in the coronary arteries in NHLBI Family Heart Study. In a cross-sectional design, we studied 1929 participants of the NHLBI Family Heart Study without known coronary heart disease. Coffee consumption was assessed by a semi-quantitative food frequency questionnaire and coronary-artery calcium (CAC) was measured by cardiac computed tomography. We defined prevalent CAC as an Agatston score of ≥100 and used generalized estimating equations to calculate prevalence ratios of CAC as well as a sensitivity analysis at a range of cutpoints for CAC. Mean age was 56.7 years and 59% of the study subjects were female. In adjusted analysis for age, sex, BMI, smoking, alcohol, physical activity, field center, and energy intake, prevalence ratio (95% CI) for CAC was 1.0 (reference), 0.92 (0.57-1.49), 1.34 (0.86-2.08), 1.30 (0.84-2.02), and 0.99 (0.60-1.64) for coffee consumption of almost never, <1/day, 1/day, 2-3/day, and ≥4 cups/day, respectively. In a sensitivity analysis, there was no evidence of association between coffee consumption and prevalent CAC when CAC cut points of 0, 50, 150, 200, and 300 were used. These data do not provide evidence for an association between coffee consumption and prevalent CAC in adult men and women.