Prevalence Of Coronary Artery Calcification Research Articles

Diagnostic Value of Coronary Artery Calcium Score for Cardiovascular Disease in African Americans: The Jackson Heart Study.

BackgroundThe role of coronary artery calcium (CAC) as a screening tool for cardiovascular disease (CVD) risk in African Americans (AAs) is unclear. We compared the diagnostic accuracy for CVD prevalence using the CAC score and the Framingham Risk Score (FRS) in an adult population of AAs.MethodsCAC was measured in 2944 participants AAs. Approximately 8% of this cohort had known CVD defined as prior myocardial infarction, stroke, percutaneous coronary intervention, coronary artery bypass grafting and peripheral artery disease. Logistic regression, receiver operating characteristic (ROC) and net reclassification index (NRI) analysis were used adjusting for age, gender, systolic blood pressure (SBP), total and high-density lipoprotein (HDL) cholesterol, smoking status, diabetes mellitus (DM), body mass index (BMI), blood pressure medication and statin use. Participants with prevalent clinical CVD and DM were classified as high FRS risk.ResultsThe mean age of participants was 60 years, 65% were females, 26% had DM, 50% were obese and 30% were current or former smokers. Prevalent CVD was associated with older age, higher SBP, lower HDL and total cholesterol, and higher CAC. The prevalence of CAC was 83% in participants with prevalent CVD and 45% in those without CVD. CAC was independently associated with prevalent CVD in our multivariable model [OR (95% CI): 1.22 (1.12–1.32), p< 0.0001]. In ROC analysis, CAC improved the diagnostic accuracy (c statistic) of the FRS from 0.617 to 0.757 (p < 0.0001) for prevalent CVD. Addition of CAC to FRS resulted in net reclassification improvement of 4% for subjects with known CVD and 28.5% in those without CVD.ConclusionIn AAs, CAC is independently associated with prevalent CVD and improves the diagnostic accuracy of FRS for prevalent CVD by 14%. Addition of CAC improves the NRI of those with prevalent CVD by 4% and the NRI of individuals without CVD by 28.5%. Determination of CAC may be useful in CVD risk stratification in AAs.

Association between nonalcoholic fatty liver disease and coronary artery calcification in postmenopausal women.

Objective:Cardiovascular disease is a leading cause of death in postmenopausal women, and nonalcoholic fatty liver disease (NAFLD) has been known to be associated with cardiovascular disease. However, little information regarding the relationship between NAFLD and coronary artery calcification (CAC) in postmenopausal women is available. The aim of this study was to investigate the association between NAFLD and CAC in postmenopausal women.Methods:Among 4,377 participants who underwent cardiac computed tomography in a health promotion center, 919 postmenopausal women were enrolled. Anthropometric profiles and multiple cardiovascular risk factors were measured. NAFLD was measured by ultrasonography, and CAC was evaluated by cardiac computed tomography. Odds ratios and 95% CI for the presence of CAC, by severity of fatty liver disease, were estimated using logistic regression.Results:Women were stratified into three groups by severity of NAFLD. There were significant differences in cardiovascular parameters among the groups, and prevalence of CAC significantly increased with severity of NAFLD. On logistic regression analysis after adjustment for multiple risk factors, the odds ratios for the prevalence of CAC were as follows (P < 0.05): no NAFLD, 1.0; mild NAFLD, 1.34 (95% CI, 0.92-2.16); moderate to severe NAFLD, 1.83 (95% CI, 1.06-3.16). However, this association was attenuated after adjustment for insulin resistance (P = 0.16).Conclusions:There is a significant correlation between NAFLD and prevalence of CAC, but NAFLD is not an independent factor for coronary atherosclerosis in postmenopausal women.

Association of Fruit and Vegetable Consumption During Early Adulthood With the Prevalence of Coronary Artery Calcium After 20 Years of Follow-Up: The Coronary Artery Risk Development in Young Adults (CARDIA) Study.

The relationship between intake of fruits and vegetables (F/V) during young adulthood and coronary atherosclerosis later in life is unclear. We studied participants of the Coronary Artery Risk Development in Young Adults (CARDIA) study, a cohort of young, healthy black and white individuals at baseline (1985-1986). Intake of F/V at baseline was assessed using a semiquantitative interview administered diet history, and coronary artery calcium was measured at year 20 (2005-2006) using computed tomography. We used logistic regression to adjust for relevant variables and estimate the adjusted odds ratios and 95% confidence intervals across energy-adjusted, sex-specific tertiles of total servings of F/V per day. Among our sample (n=2506), the mean (SD) age at baseline was 25.3 (3.5) years, and 62.7% were female. After adjustment for demographics and lifestyle variables, higher intake of F/V was associated with a lower prevalence of coronary artery calcium: odds ratio (95% confidence interval) =1.00 (reference), 0.78 (0.59-1.02), and 0.74 (0.56-0.99), from the lowest to the highest tertile of F/V, P value for trend <0.001. There was attenuation of the association between F/V and coronary artery calcium after adjustment for other dietary variables, but the trend remained significant: odds ratio (95% confidence interval): 1.00 (reference), 0.84 (0.63-1.11), and 0.92 (0.67-1.26), P value for trend <0.002]. In this longitudinal cohort study, higher intake of F/V during young adulthood was associated with lower odds of prevalent coronary artery calcium after 20 years of follow-up. Our results reinforce the importance of establishing a high intake of F/V as part of a healthy dietary pattern early in life.

Circulation : Clinical Summaries

<i>Circulation</i> : Clinical Summaries

Abstract 19690: Association of Pericardial Fat Density With Progression of Coronary Artery Calcification Differs by Diabetes Status in the CACTI Study

Density of adipose tissue can be measured by CT attenuation in Hounsfield Units (HU). Increased visceral fat density has been associated with coronary artery calcification (CAC). However, the relationship between pericardial fat density and CAC is unknown. We examined the association of pericardial fat density (PAT HU) with the presence (CAC &gt; 0) and progression of CAC in the Coronary Artery Calcification in Type 1 Diabetes study (CACTI). CACTI is a prospective cohort study of adults with and without type 1 diabetes (T1D) with a mean age of 38 years (±9) at baseline. Participants were free of CVD at the time of enrollment in the study. PAT volume was measured from baseline EBCT scans within a range of HU from -190 to -30. CAC was measured at baseline and at the follow-up exam with a mean follow-up of 6 years (±0.5). Logistic regression was used to examine the association between PAT HU and CAC. Prevalence of CAC was defined as any CAC (&gt;0) at baseline. Progression of CAC was defined as a change in volume of ≥2.5 square-root transformed units between the baseline and followup exams. PAT volume and triglycerides were log transformed. Interaction terms for diabetes and PAT HU were tested in the models. PAT data were available on 1319 subjects for the prevalence model, and 952 for the progression model. PAT HU was significantly higher (less-negative) in those with T1D compared to those without (-75.7 ±3.7 vs -77.8 ±4.2; p&lt;0.001). Results from the regression models are shown in table 1. Increasing PAT HU was significantly associated with the prevalence of CAC in both those with T1D and without. However, increasing PAT HU was significantly associated with progression of CAC only in those with T1D. These results suggest that higher PAT fat density may be an important factor in subclinical atherosclerosis, particularly for those with T1D.

Abstract 15016: Calcifications of Aortic Valve, Coronary Arteries and Aorta in 500 Consecutive Patients

Introduction: Diseases presenting with cardiac and vascular calcification are well known and a variety of diagnostic modalities enable detection of calcifications. However, the relationship between calcification of arteries and the aortic valve together with corresponding pathophysiological processes have not been yet unequivocally elucidated. Purposes of the study: An assessment of correlation between presence and severity of calcifications in the aortic valve, coronary arteries, aorta and influence of cardiovascular disease risk factors on prevalence of calcifications in this locations. Material and Methods: The study included consecutive patients over 60 years of age referred for computed tomography imaging of coronary artery disease. A total number of included patients reached 500 subjects. Besides coronary artery calcification (CAC), we evaluated aortic valve calcification (AVC) and ascending aorta calcification (AAC). Computed tomography examinations were performed with a dual-source, 64-slice scanner. Exclusion criteria encompassed: diagnosed aortic valve disease, history of coronary artery angioplasty, bypass grafting or heart valve surgery. Results: AVC was diagnosed in 163 patients (32.6%). Prevalence of CAC and AAC was higher than AVC and amounted to 78.8% and 59.8%, respectively. Aortic valve calcification was more often observed in men than women. Degree of AVC severity was significantly lesser than that of CAC and AAC (p=0.0001, p=0.0001). In our study population, we did not find a significant dependence between presence and severity of AVC and CAC or AAC. However, we did observe a statistically significant relationship between presence and severity of CAC and AAC. In contrast to coronary arteries and the aorta, we did not find significantly increased prevalence of AVC among patients with arterial hypertension, dyslipidemias, diabetes, smokers or patients with elevated BMI. Only sex and age exerted significant influence on development of AVC. Conclusions: Despite some similarities between the process of aortic valve calcification and that involving coronary arteries and aorta, these phenomena are not interrelated. It seems that process of calcification of the aortic valve is significantly different from atherosclerosis.

Abstract 11932: Timing of Hormone Replacement Therapy and Coronary Artery Calcium: The Multi Ethnic Study of Atherosclerosis

Introduction: Cardiovascular disease is a leading cause of mortality in post-menopausal women. Although hormone replacement therapy (HRT) is not recommended for prevention of coronary artery disease, recent evidence suggests the timing of HRT may derive different effects on atherosclerosis formation. Hypothesis: We hypothesize that women who are given HRT closer to the onset of menopause will have less coronary artery calcium (CAC). Method: Study participants were 3,174 women from the Multi-Ethnic Study of Atherosclerosis (MESA). Women who had not yet started menopause, had started menopause but not yet started HRT, had started HRT before menopause, or did not report age of menopause and/or starting HRT were excluded. To evaluate the association between presence of CAC and timing of HRT, we used logistic regression with presence of CAC as the response and with timing of HRT as a continuous linear predictor. We also used predefined categories of the timing of HRT as a predictor. Result: Among the 1396 participants who had gone through or were going through menopause and started HRT post-menopause, the prevalence of CAC was 42%, the mean of CAC was 77 (221) Agatston units, and the median was 0 (0-34).The odds of having CAC was 1.06 (95% CI: 1.04, 1.08; p&lt;0.001) times higher for starting HRT 1 year later post-menopause. The odds ratio was 1.03 (1.01, 1.04; p=0.008; N=1358) after adjustment for traditional cardiovascular risk factors, 1.02 (1.00, 1.05; p=0.02; N=1336) after further adjustment for duration of HRT, and 1.01 (0.99, 1.04; p=0.3; N=839) after further adjustment for type of HRT. The mean difference in CAC associated with starting HRT 1 year later post-menopause was 5.1 Agatston units (3.0, 7.2; P&lt;0.0001); the mean difference was smaller and not significantly different from 0 after adjustment for other risk factors. Conclusion: While this study does not provide evidence that the timing of HRT post-menopause is associated with the amount of CAC, it does provide evidence that starting HRT earlier post menopause is associated with lower odds of CAC.

Abstract 12119: Class I Indication for Statin Therapy in Primary Prevention by Three Cholesterol Guidelines and Prevalence of Coronary Artery Calcium in Asymptomatic Adults: Multi-ethnic Study of Atherosclerosis (MESA)

Introduction:Statin therapy for secondary prevention of atherosclerotic cardiovascular disease (ASCVD) events provides greater relative risk reduction compared with primary prevention. Coronary artery calcium (CAC) identifies individuals with established but subclinical ASCVD disease. Identifying a population with a higher prevalence of CAC may improve the benefit and efficacy of statin therapy in the primary prevention of ASCVD. We assessed the accuracy of class I statin eligibility criterion for primary prevention by the 2013 ACC/AHA cholesterol guidelines for the presence of CAC and compared it with class I criterion for lipid lowering therapy eligibility by the 2004 NCEP/ATP III and 2011 ESC/EAS cholesterol guidelines. Methods:4723 out of the 6814 total participants not taken statins during the baseline exam and with complete data including CAC were included in analysis. We evaluated the sensitivity (SN), specificity (SP), positive predictive value (PPV), negative predictive value (NPV) of class I recommendation for lipid lowering therapy (high risk designation) by the three cholesterol guidelines for three categories of prevalent CAC [CAC present/absent; CAC ≥ 100; CAC ≥300 Agatston] in participants of the Multi Ethnic Study of Atherosclerosis (MESA) Results:Mean age 59±9 years, 47% male, 37% white, 28% black, 23% Hispanic, 12% Asian, 7.5% with diabetes, 35% current/former smokers, mean glomerular filtration rate of 83±18 ml/min and mean BMI of 28±6 kg/m2. 1978(41.9%), 816(17.3%) and 392(8.3%) had CAC present, CAC ≥100 and CAC ≥300 respectively. Table 1 shows the results. Conclusions:The SN, SP, PPV and NPV of class I statin eligibility criteria by the 3 guidelines for subclinical ASCVD depends significantly on the definition of CAC. The 2013 ACC/AHA class I statin eligibility has a higher SN, lower SP, and higher NPV when compared with the 2004 NCEP/ATP III and 2011 ESC/EAS class I criterion for statin therapy across all three CAC categories.

Abstract 19899: Coffee Consumption is Not Associated With Calcified Atherosclerotic Plaques in the Coronary Arteries: The NHLBI Family Heart Study

Introduction: The average consumption of coffee per day in the United States is 3.2 cups. While in a recent meta-analysis of 21 prospective studies, coffee consumption was associated with a lower risk of cardiovascular disease mortality, with the lowest risk observed among consumers of 4 cups/day, limited and inconsistent data are available on the relation of coffee intake with subclinical disease. Hypothesis: Our primary hypothesis is that coffee consumption is inversely associated with the prevalence of atherosclerotic plaque in coronary arteries in NHLBI Family Heart Study Methods: 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 CT. We defined prevalent CAC using an Agatston score of at least 100 and fitted generalized estimating equations to calculate prevalence odds ratios of CAC. Results: Mean age and BMI were 56.7 years and 28.8 kg/m2 respectively, and 59% were male. In crude analysis, higher coffee consumption was associated with higher prevalence of CAC. Odds ratio (95%CI) for CAC were 1.0 (reference), 1.34 (0.92-1.94), 2.48 (1.81-3.40), 2.45 (1.82-3.30), and 1.81 (1.29-2.56) for coffee consumption of almost never, &lt;1/day, 1/day, 2-3/day, and ≥4 cups/day. However, controlling for potential confounding factors eliminated such association [Corresponding odds ratio (95%CI) for CAC: 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), respectively, adjusting for age, sex, BMI, smoking, alcohol, physical activity, field center, and total calories]. Conclusions: These data do not provide evidence for an association between coffee consumption and prevalent CAC in adult men and women.

Abstract 12101: Family History of Coronary Heart Disease and Coronary Artery Calcium in South Asians and 4 Other Racial/Ethnic Groups in the US: The Mediators of Atherosclerosis in South Asians Living in America study and the Multi-Ethnic Study of Atherosclerosis

Introduction: High coronary heart disease (CHD) rates among South Asians (SAs) are not fully explained by traditional risk factors. The association of a family history of CHD (FH) with subclinical atherosclerosis as measured by coronary artery calcium (CAC) in SAs is unknown. Hypothesis: FH is significantly and independently associated with CAC presence and burden in SAs and other ethnicities. Methods: We included all participants aged 45-84 years from two community-based populations: the MASALA study of SAs and the MESA study of Non-Hispanic Whites (NHWs), African Americans (AAs), Chinese Americans (CAs), and Hispanics (HPs). All participants underwent baseline CAC scanning. FH was defined as a self-reported history of CHD in a first-degree relative. We used multivariable regression models to assess the association of FH with CAC (&gt;0 and &gt;100) and likelihood ratio tests to assess the incremental predictive ability of FH to identify CAC (&gt;0 and &gt;100) when added to the 2013 ACC/AHA ASCVD risk estimate in each racial/ethnic group. Results: Baseline demographics are shown in the table. NHWs, AAs, and HPs with a FH had a significantly higher proportion of CAC&gt;0 and CAC&gt;100 than those without FH. In unadjusted and multivariable analyses, FH was significantly associated with CAC burden in NHWs, AAs, and HPs, but not in CAs or SAs (Table). Similarly, FH significantly added to the ASCVD risk estimate in predicting prevalent CAC&gt;0 and CAC&gt;100 in NHWs, AAs, and HPs (p-values &lt;0.01 for all), but not in CAs (p-value 0.151 and 0.362) or in SAs (p-value 0.778 and 0.216, respectively). In a sensitivity analysis, FH was significantly associated with very high CAC&gt;400 in SAs, but not in CAs. Conclusion: FH was strongly and independently associated with CAC burden in NHWs, AAs, and HPs; this association was weaker and non-significant in CAs and SA in the US. Understanding the reasons behind these findings will require evaluation in larger populations of CAs and SAs with detailed ascertainment of FH.

Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Risk Score in Young Adults Predicts Coronary Artery and Abdominal Aorta Calcium in Middle Age: The CARDIA Study.

We explored whether, the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) coronary and abdominal risk scores measured at 18 to 30 years of age and changes in these scores would more strongly predict coronary artery calcium (CAC) and abdominal aortic calcium (AAC) assessed 25 years later, than scores measured 25 years later. In the Coronary Artery Risk Development in Young Adults (CARDIA) study, 3008 participants had measurements of risk score components at 5-year intervals beginning at 18 to 30 years of age. CAC and AAC were assessed at 43 to 55 years of age. Odds ratios (ORs) for the presence and extent of CAC/AAC per/point higher score and c-statistics for predicting CAC/AAC were calculated. The prevalence of CAC was 28% and AAC was 53%. For each 1 point higher PDAY score, the odds of CAC were higher using baseline scores than year 25 scores (OR, 1.29; 95% confidence interval [CI], 1.25-1.33 versus OR, 1.12; 95% CI, 1.11-1.14). For AAC, ORs at years 0 and 25 were similar (OR, 1.29; 95% CI, 1.24-1.34 versus OR, 1.22; 95% CI, 1.19-1.26). C-statistic for CAC prediction was higher at year 0 than year 25 (0.731 versus 0.705) but similar at years 0 and 25 for AAC (0.665 versus 0.670). ORs for CAC were highest at baseline, and, for AAC, ORs were highest at year 10. Including change in PDAY scores with baseline scores improved prediction. Atherosclerosis risk and change in risk assessed in young adulthood years before subclinical atherosclerosis imaging provide strong prediction of future subclinical atherosclerosis. CAC and AAC reflect chronic risk exposure in addition to risk measured at the time of study.

Coronary Artery Calcium Score and Association with Recurrent Nephrolithiasis: The Multi-Ethnic Study of Atherosclerosis

Subclinical coronary artery calcification is an established predictor of cardiovascular events. While a history of kidney stones has been linked to subclinical carotid atherosclerosis, to our knowledge no study has examined its relationship with coronary artery calcification. We studied the association between kidney stone history and prevalent coronary artery calcification in MESA (Multi-Ethnic Study of Atherosclerosis). MESA is a multisite cohort study of participants 45 to 84 years old without known cardiovascular disease at baseline from 2000 to 2002. Computerized tomography was done in 3,282 participants at followup in 2010 to2012 to determine coronary artery calcification and kidney stone history was assessed by self-report. Coronary artery calcification scores were categorized as none-0, mild-1 to 99, moderate-100 to 399 or severe-400 or greater. Cross-sectional analysis was performed adjusting for demographic and dietary factors related to kidney stones. The prevalence of kidney stone disease history was approximately 9%, mean ± SD participant age was 69.5 ± 9.3 years, 39% of participants were Caucasian, 47% were men and 69% had detectable coronary artery calcification (score greater than 0). No difference in the score was seen between single stone formers and nonstone formers. Recurrent kidney stone formation was associated with moderate or severe calcification on multivariable logistic regression vs none or mild calcification (OR 1.80, 95% CI 1.22-2.67). When coronary artery calcification scores were separated into none, mild, moderate and severe calcification, recurrent stone formation was associated with a higher score category on multivariable ordinal logistic regression (OR 1.44 per category, 95% CI 1.04-2.01). Recurrent kidney stone formation is associated with subclinical coronary atherosclerosis. This association appeared stronger with coronary artery calcification severity than with coronary artery calcification presence.

Subclinical Atherosclerosis and Relationship With Risk Factors of Coronary Artery Disease in a Rural Population

BackgroundAnnually, over 150,000 cardiovascular events occur among individuals <65 years old in the United States, including asymptomatic ones. Coronary artery calcium (CAC), a subclinical marker of coronary artery disease (CAD), enhances risk stratification among asymptomatic individuals. This study assessed the prevalence of CAC in a rural population and determined relationships between traditional risk factors for CAD and CAC scores. MethodsDuring January 2011 to December 2012, asymptomatic individuals from central Appalachia were screened for CAC in the largest tertiary cardiovascular institute. Based on Agatston scale, participants were grouped into 4 CAC scores: zero (CAC = 0), mild (CAC = 1–99), moderate (CAC = 100–399) and severe (CAC ≥ 400). Multinomial logistic regression was used to examine associations between potential risk factors of CAD and CAC score. ResultsOf 1,674 participants, 55.4% had positive CAC score (CAC > 0). Increasing age and being male were positively associated with higher CAC scores. Although there was significant association between mild CAC and hypertension and family history of CAD, moderate CAC was positively associated with smoking status. Except hypercholesterolemia and sedentary lifestyle, severe CAC was significantly associated with major health conditions (obesity, diabetes and hypertension), lifestyle (smoking) and family history of CAD. ConclusionsMore than half of participants in the CAC screening had subclinical CAD (CAC score > 0). The association between CAC score and CAD risk factors suggests that education about subclinical atherosclerosis among asymptomatic individuals in this region with high cardiovascular disease prevalence is needed because CAC improves CAD risk stratification, and the knowledge of CAC enhances medication adherence and motivates individuals towards beneficial behavioral/lifestyle modification.

A Cross-sectional Study of the Association Between Chronic Hepatitis C Virus Infection and Subclinical Coronary Atherosclerosis Among Participants in the Multicenter AIDS Cohort Study.

Hepatitis C virus (HCV) infection may increase the risk of cardiovascular disease (CVD). We evaluated the association of chronic HCV infection and coronary atherosclerosis among participants in the Multicenter AIDS Cohort Study. We assessed 994 men with or without human immunodeficiency virus (HIV) infection (87 of whom had chronic HCV infection) for coronary plaque, using noncontrast coronary computed tomography (CT); 755 also underwent CT angiography. We then evaluated the associations of chronic HCV infection and HIV infection with measures of plaque prevalence, extent, and stenosis. After adjustment for demographic characteristics, HIV serostatus, behaviors, and CVD risk factors, chronic HCV infection was significantly associated with a higher prevalence of coronary artery calcium (prevalence ratio, 1.29; 95% confidence interval [CI], 1.02-1.63), any plaque (prevalence ratio, 1.26; 95% CI, 1.09-1.45), and noncalcified plaque (prevalence ratio, 1.42; 95% CI, 1.16-1.75). Chronic HCV infection and HIV infection were independently associated with the prevalence of any plaque and of noncalcified plaque, but there was no evidence of a synergistic effect due to HIV/HCV coinfection. The prevalences of coronary artery calcium, any plaque, noncalcified plaque, a mixture of noncalcified and calcified plaque, and calcified plaque were significantly higher among men with an HCV RNA load of ≥2 × 10(6) IU/mL, compared with findings among men without chronic HCV infection. Chronic HCV infection is associated with subclinical CVD, suggesting that vigilant assessments of cardiovascular risk are warranted for HCV-infected individuals. Future research should determine whether HCV infection duration or HCV treatment influence coronary plaque development.

Objectively measured sleep characteristics and prevalence of coronary artery calcification: the Multi-Ethnic Study of Atherosclerosis Sleep study

BackgroundWe tested whether objectively measured indices of obstructive sleep apnoea (OSA) and sleep quality are associated with coronary artery calcification (CAC) prevalence independent of obesity, a classic confounder.Methods1465 Multi-Ethnic Study...

Comparison of Frequency and Duration of Periodontal Disease With Progression of Coronary Artery Calcium in Patients With and Without Type 1 Diabetes Mellitus

People with type 1 diabetes mellitus manifest a greater burden of both periodontal disease and coronary artery disease (CAD); however, little is known about their interrelation. Coronary artery calcium (CAC) measures subclinical atherosclerosis and predicts major adverse coronary events. The relation between periodontal disease and CAC progression in individuals with type 1 diabetes has not been previously described. We determined the prevalence and progression of CAC in relation to self-reported periodontal disease. Multivariate logistic and tobit regression models were used to examine the relation between periodontal disease duration and CAC progression and whether this relation differs by diabetes status after controlling for age, gender, total and high-density lipoprotein cholesterol, hypertension, smoking, body mass index (BMI), duration of diabetes, and baseline CAC. A total of 473 patients with type 1 diabetes and 548 without diabetes were followed for a mean of 6.1 years. At baseline, the prevalence and duration of periodontal disease did not differ between subjects with and without diabetes (14.5% vs 13.4%, p = 0.60; 6 vs 9 years, p = 0.18). Duration of periodontal disease was not significantly associated with baseline CAC prevalence. In patients with type 1 diabetes, periodontal disease duration was significantly related to CAC progression (p = 0.004) but not in subjects without diabetes (p = 0.63). In conclusion, this study suggests that periodontal disease is an independent predictor of long-term progression of CAC in patients with type 1 diabetes.

Coronary calcification in SLE: comparison with the Multi-Ethnic Study of Atherosclerosis.

Accelerated atherosclerosis is a major cause of morbidity and death in SLE. The purpose of this study was to determine whether the prevalence and extent of coronary artery calcium (CAC) is higher in female SLE patients compared with a non-SLE sample from the Multi-Ethnic Study of Atherosclerosis (MESA). CAC was measured in 80 female SLE patients and 241 female MESA controls from the Baltimore Field Centre, ages 45-64 years, without evidence of clinical cardiovascular disease. Binary regression was used to estimate the ratio of CAC prevalence in SLE vs MESA controls, controlling for demographic and cardiovascular risk factors. To compare the groups with respect to the quantity of CAC among those with non-zero Agatston scores, we used linear models in which the outcome was a log-transformed Agatston score. The prevalence of CAC was substantially higher in SLE. The differences were most pronounced and statistically significant in those aged 45-54 years (58% vs 20%, P < 0.0001), but were still observed among those aged 55-65 years (57% vs 36%, P = 0.069). After controlling for age, ethnicity, education, income, diabetes mellitus, hypertension, hyperlipidaemia, high-density lipoprotein levels, smoking, education and BMI, SLE patients still had a significantly higher prevalence of CAC than controls. Among those with CAC, the mean log Agatston score did not differ significantly between SLE and MESA participants. Women with SLE have a higher prevalence of CAC than comparable women without SLE, even after adjusting for traditional cardiovascular risk factors, especially among those aged 45-54 years.

Relationship of pericardial fat with lipoprotein distribution: The Multi-Ethnic study of atherosclerosis.

Pericardial fat and lipoprotein abnormalities contribute to increased risk of cardiovascular disease (CVD). We investigated the relationship between pericardial fat volume and lipoprotein distribution, and whether the association of pericardial fat volume with subclinical atherosclerosis and incident CVD events differs according to lipoprotein distribution. We analyzed data from 5407 participants from the Multi-Ethnic Study of Atherosclerosis who had measurements of pericardial fat volume, lipoprotein distribution, carotid intima-media thickness (IMT), and coronary artery calcium (CAC). All participants were free of clinically apparent CVD at baseline. Incident CVD was defined as any adjudicated CVD event. After adjusting for demographic factors, traditional risk factors, and biomarkers of inflammation and hemostasis, a larger pericardial fat volume was associated with higher large VLDL particle (VLDL-P) concentration and small HDL particle (HDL-P) concentration, and smaller HDL-P size (regression coefficients=0.585nmol/L, 0.366μmol/L, and-0.025nm per SD increase in pericardial fat volume respectively, all P<0.05). The association of pericardial fat volume with large VLDL-P concentration and HDL-P size, but not small HDL-P concentration, remained significant after further adjusting for each other as well as LDL cholesterol, HDL cholesterol, and triglycerides. The relationship of pericardial fat volume with incident CVD events, carotid IMT, and prevalence and severity of CAC did not differ by quartiles of large VLDL-P concentration, small HDL-P concentration, or HDL-P size (P for interaction>0.05). Pericardial fat is associated with atherogenic lipoprotein abnormalities. However, its relationship with subclinical atherosclerosis and incident CVD events does not differ according to lipoprotein distribution.

Egg consumption and coronary artery calcification in asymptomatic men and women.

The association of egg consumption with subclinical coronary atherosclerosis remains unknown. Our aim was to examine the association between egg consumption and prevalence of coronary artery calcium (CAC). Cross-sectional study of 23,417 asymptomatic adult men and women without a history of cardiovascular disease (CVD) or hypercholesterolemia, who underwent a health screening examination including cardiac computed tomography for CAC scoring and completed a validated food frequency questionnaire at the Kangbuk Samsung Hospital Total Healthcare Centers, South Korea (March 2011-April 2013). The prevalence of detectable CAC (CAC score>0) was 11.2%. In multivariable-adjusted models, CAC score ratio (95% confidence interval [CI]) comparing participants eating≥7 eggs/wk to those eating<1 egg/wk was 1.80 (1.14-2.83; P for trend=0.003). The multivariable CAC score ratio (95% CI) associated with an increase in consumption of 1 egg/day was 1.54 (1.11-2.14). The positive association seemed to be more pronounced among participants with low vegetable intake (P for interaction=0.02) and those with high BMI (P for interaction=0.05). The association was attenuated and no longer significant after further adjustment for dietary cholesterol. Egg consumption was associated with an increased prevalence of subclinical coronary atherosclerosis and with a greater degree of coronary calcification in asymptomatic Korean adults, which may be mediated by dietary cholesterol. The association was particularly pronounced among individuals with low vegetable intake and those with high BMI.

Brachial-ankle pulse wave velocity is associated with coronary calcium in young and middle-aged asymptomatic adults: The Kangbuk Samsung Health Study.

To evaluate the association between brachial-ankle pulse wave velocity (baPWV), a convenient, non-radiating, readily available measurement of arterial stiffness, and coronary artery calcium (CAC), a reliable marker of coronary atherosclerosis, in a large sample of young and middle-aged asymptomatic adults; and to assess the incremental value of baPWV for detecting prevalent CAC beyond traditional risk factors. Cross-sectional study of 15,185 asymptomatic Korean adults who voluntarily underwent a comprehensive health screening program including measurement of baPWV and CAC. BaPWV was measured using an oscillometric method with cuffs placed on both arms and ankles. CAC burden was assessed using a multi-detector CT scan and scored following Agatston's method. The prevalence of CAC>0 and CAC>100 increased across baPWV quintiles. The multivariable-adjusted odds ratios (95% CI) for CAC>0 comparing baPWV quintiles 2-5 versus quintile 1 were 1.06 (0.87-1.30), 1.24 (1.02-1.50), 1.39 (1.15-1.69) and 1.60 (1.31-1.96), respectively (P trend<0.001). Similarly, the relative prevalence ratios for CAC>100 were 1.30 (0.74-2.26), 1.59 (0.93-2.71), 1.74 (1.03-2.94) and 2.59 (1.54-4.36), respectively (P trend<0.001). For CAC>100, the area under the ROC curve for baPWV alone was 0.71 (0.68-0.74), and the addition of baPWV to traditional risk factors significantly improved the discrimination and calibration of models for detecting prevalent CAC>0 and CAC>100. BaPWV was independently associated with the presence and severity of CAC in a large sample of young and middle-aged asymptomatic adults. BaPWV may be a valuable tool for identifying apparently low-risk individuals with increased burden of coronary atherosclerosis.