Association of cardiovascular disease risk factors with coronary artery calcium volume versus density

Isac C. Thomas*, Brandon Shiau, Julie O. Denenberg, Robyn L. McClelland, Philip Greenland, Ian H. De Boer, Bryan R. Kestenbaum, Gen Min Lin, Michael Daniels, Nketi I. Forbang, Dena E. Rifkin, Jan Hughes-Austin, Matthew A. Allison, J. Jeffrey Carr, Joachim H. Ix, Michael H. Criqui

*Corresponding author for this work

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

Objectives Recently, the density score of coronary artery calcium (CAC) has been shown to be associated with a lower risk of cardiovascular disease (CVD) events at any level of CAC volume. Whether risk factors for CAC volume and CAC density are similar or distinct is unknown. We sought to evaluate the associations of CVD risk factors with CAC volume and CAC density scores. Methods Baseline measurements from 6814 participants free of clinical CVD were collected for the Multi-Ethnic Study of Atherosclerosis. Participants with detectable CAC (n=3398) were evaluated for this study. Multivariable linear regression models were used to evaluate independent associations of CVD risk factors with CAC volume and CAC density scores. Results Whereas most CVD risk factors were associated with higher CAC volume scores, many risk factors were associated with lower CAC density scores. For example, diabetes was associated with a higher natural logarithm (ln) transformed CAC volume score (standardised β=0.44 (95% CI 0.31 to 0.58) ln-units) but a lower CAC density score (β=-0.07 (-0.12 to-0.02) density units). Chinese, African-American and Hispanic race/ethnicity were each associated with lower ln CAC volume scores (β=-0.62 (-0.83to-0.41),-0.52 (-0.64 to-0.39) and-0.40 (-0.55 to-0.26) ln-units, respectively) and higher CAC density scores (β= 0.41 (0.34 to 0.47), 0.18 (0.12 to 0.23) and 0.21 (0.15 to 0.26) density units, respectively) relative to non-Hispanic White. Conclusions In a cohort free of clinical CVD, CVD risk factors are differentially associated with CAC volume and density scores, with many CVD risk factors inversely associated with the CAC density score after controlling for the CAC volume score. These findings suggest complex associations between CVD risk factors and these components of CAC.

Original languageEnglish (US)
Pages (from-to)135-141
Number of pages7
JournalHeart
Volume104
Issue number2
DOIs
StatePublished - Jan 2018

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Thomas, I. C., Shiau, B., Denenberg, J. O., McClelland, R. L., Greenland, P., De Boer, I. H., Kestenbaum, B. R., Lin, G. M., Daniels, M., Forbang, N. I., Rifkin, D. E., Hughes-Austin, J., Allison, M. A., Carr, J. J., Ix, J. H., & Criqui, M. H. (2018). Association of cardiovascular disease risk factors with coronary artery calcium volume versus density. Heart, 104(2), 135-141. https://doi.org/10.1136/heartjnl-2017-311536