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Coronary Calcification and CHD Events in the MESA Study

Coronary Calcification and CHD Events in the MESA Study. Robert Detrano Alan Guerci Jeffrey Carr Diane Bild Gregory Burke Aaron Folsom Kiang Liu Steve Shea Moyses Szklo David Bluemke Dan O’Leary Karol Watson Nathan Wong Richard Kronmal. CHD Events (MI, CHD Death) in MESA.

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Coronary Calcification and CHD Events in the MESA Study

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  1. Coronary Calcification and CHD Events in the MESA Study • Robert Detrano • Alan Guerci • Jeffrey Carr • Diane Bild • Gregory Burke • Aaron Folsom • Kiang Liu • Steve Shea • Moyses Szklo • David Bluemke • Dan O’Leary • Karol Watson • Nathan Wong • Richard Kronmal

  2. CHD Events (MI, CHD Death) in MESA

  3. Gender vs. CHD

  4. Race vs. CHD

  5. Events vs time Models and display of data for CAC in four intervals used in Greenland JAMA paper.

  6. Cox Regression, Risk Factors and Calcium --------------------------------------------------------------------------- Variable Haz. Ratio P>|z| [95% Conf. Interval] -------------+---------------------------------------------------------------- log (CAC + 1) | 1.31 0.000 1.16 1.47 Age | 1.03 0.061 1.00 1.07 Black | 0.74 0.496 0.30 1.78 Chinese | 0.71 0.302 0.37 1.36 Hispanic | 0.86 0.631 0.45 1.61 Male | 2.73 0.002 1.44 5.20 Former Smoker | 0.91 0.731 0.53 1.57 Current Smoker | 1.94 0.057 0.98 3.86 Diabetes | 1.88 0.052 0.99 3.54 Anti-hypertensive | 1.05 0.860 0.62 1.78 Systolic BP | 1.01 0.073 1.00 1.03 Diastolic BP | 0.99 0.383 0.95 1.02 HDL | 0.99 0.490 0.97 1.01 Total Cholesterol | 1.01 0.002 1.00 1.01 Lipid lowering Meds| 1.39 0.259 0.79 2.44 ------------------------------------------------------------------------------

  7. . ROC Area [95% CI] Raggi (01) Arad (96) Greenland (04) ---------------------------------------------------------------------------------------------- CACS 0.76 0.70 0.81 0.91 Fram (RF) 0.72 0.66 0.79 0.71 0.74 0.63 Fram + CACS 0.78 0.73 0.83 0.84 0.68 ------------------------------------------------------------------------------------------ Ho: area(predcac) = area(predfram) = area(predcacfram) chi2(2) = 49.63 Prob>chi2 = 0.0000

  8. Questions • Events: Stroke, etc? • CRP? • Other? • Author’s names, affiliation? • Follow-up time

  9. CAC in four intervals versus hard CHD events MI or CHD death are 11 times as likely in those with coronary calcium as in those without coronary calcium

  10. MESA Description

  11. Research Hypotheses: • When adjusted for standard risk factors, coronary calcium predicts near-term CHD/CVD events in asymptomatic adults. • Coronary calcium will add additional discriminatory power when included in risk models beyond that of standard models using standard risk factors alone.

  12. MESA Description ● N=6,814 recruited 2000-2002 ● 45-84 years ● 53% women ● no clinical CVD

  13. Measurements ●Coronary calcium by computed tomography - EBT in 3 centers - MDCT (Siemens or GE) in 3 centers - Agatston score, phantom-adjusted - Prevalence based on score >0

  14. Measurements ●Age, ethnicity ● Anthropometry, blood pressure ● LDL-, HDL-cholesterol, triglycerides ● Smoking ● Diabetes, hypertension ● Medications for high cholesterol Clinical Events (CHD Death, MI, Angina Requiring Hospitalization)

  15. Events • Telephone contacts every 9-12 months. • Death certificates and medical records for all hospitalizations and outpatient cardiovascular diagnoses. (98%) • Next of kin interviews for out of hospital cardiovascular deaths. • Endpoint adjudication by cardiologists, neurologists or cardiovascular epidemiologists. • CHF, angina, myocardial infarction, resuscitated cardiac arrest, peripheral arterial disease, stroke, and TIA--fatal CHD, fatal stroke, and other fatal CVD.??????

  16. Framingham Risk

  17. Conclusions • Coronary calcium is an independent predictor of CHD events in asymptomatic adults. • Coronary calcium adds independent predictive discrimination when compared to the Framingham risk equation

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