Abstract
Background: The 2018 American Heart Association/American College of Cardiology/Multisociety cholesterol guideline states that statin therapy may be withheld or delayed among intermediate-risk individuals in the absence of coronary artery calcium (CAC=0). We evaluated whether traditional cardiovascular risk factors are associated with incident atherosclerotic cardiovascular disease (ASCVD) events among individuals with CAC=0 over long-term follow-up. Methods: We included participants with CAC=0 at baseline from the MESA (Multi-Ethnic Study of Atherosclerosis), a prospective cohort study of individuals free of clinical ASCVD at baseline. We used multivariable-adjusted Cox proportional hazards models to study the association between cardiovascular risk factors (cigarette smoking, diabetes, hypertension, preventive medication use [aspirin and statin], family history of premature ASCVD, chronic kidney disease, waist circumference, lipid and inflammatory markers) and adjudicated incident ASCVD outcomes. Results: We studied 3416 individuals (mean [SD] age 58 [9] years; 63% were female, 33% White, 31% Black, 12% Chinese American, and 24% Hispanic). Over a median follow-up of 16 years, there were 189 ASCVD events (composite of coronary heart disease and stroke) of which 91 were coronary heart disease, 88 were stroke, and 10 were both coronary heart disease and stroke events. The unadjusted event rates of ASCVD were ≤5 per 1000 person-years among individuals with CAC=0 for most risk factors with the exception of current cigarette smoking (7.3), diabetes (8.9), hypertension (5.4), and chronic kidney disease (6.8). After multivariable adjustment, risk factors that were significantly associated with ASCVD included current cigarette smoking: hazard ratio, 2.12 (95% CI, 1.32-3.42); diabetes: hazard ratio, 1.68 (95% CI, 1.01-2.80); and hypertension: hazard ratio, 1.57 (95% CI, 1.06-2.33). Conclusions: Current cigarette smoking, diabetes, and hypertension are independently associated with incident ASCVD over a 16-year follow-up among those with CAC=0.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 259-267 |
| Number of pages | 9 |
| Journal | Circulation |
| Volume | 145 |
| Issue number | 4 |
| DOIs | |
| State | Published - Jan 25 2022 |
Funding
The MESA projects are conducted and supported by the National Heart, Lung, and Blood Institute (NHLBI) in collaboration with MESA investigators. Support for MESA is provided by contracts 75N92020D00001, HHSN268201500003I, N01-HC-95159, 75N92020D00005, N01-HC-95160, 75N92020D00002, N01-HC-95161, 75N92020D00003, N01-HC-95162, 75N92020D00006, N01-HC-95163, 75N92020D00004, N01-HC-95164, 75N92020D00007, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168, N01-HC-95169, UL1-TR-000040, UL1-TR-001079, and UL1-TR-001420. Also supported in part by the National Center for Advancing Translational Sciences, Clinical & Translational Science Institute grant UL1TR001881, and the National Institute of Diabetes and Digestive and Kidney Disease Diabetes Research Center grant DK063491 to the Southern California Diabetes Endocrinology Research Center. Dr Virani has received research support from Department of Veterans Affairs, World Heart Federation, and Tahir and Jooma Family; honorarium: American College of Cardiology (Associate Editor for Innovations, acc.org). Dr Shea has received funding from the National Heart, Lung, and Blood Institute. Dr Greenland has received grants from National Institutes of Health (NIH) and American Heart Association (AHA). Dr Nambi was supported by a VA Merit grant. He is co-investigator on a provisional patent along with Roche, Baylor College of Medicine on the use of biomarkers in prediction of heart failure, and he is site principal investigator for study sponsored by Amgen. Dr Ballantyne has received grant/research support: All significant (all paid to institution, not individual): Abbott Diagnostic, Akcea, Amgen, Esperion, Ionis, Novartis, Regeneron, Roche Diagnostic, NIH, AHA, and the American Diabetes Association. He is a consultant for Abbott Diagnostics, Althera, Amarin,* Amgen, Arrowhead, Astra Zeneca, Corvidia, Denka Seiken,* Esperion, Genentech, Gilead, Matinas BioPharma Inc, New Amsterdam,* Novartis, Novo Nordisk, Pfizer, Regeneron, Roche Diagnostic, and Sanofi-Synthelabo* (*significant where noted [>$10 000]; remainder modest [<$10 000]). The remaining coauthors report no relevant conflicts of interest.
Keywords
- carotid artery diseases
- coronary artery disease
- heart disease risk factors
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Physiology (medical)
