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Association of Coronary Artery Calcium and Coronary Heart Disease Events in Young and Elderly Participants in the Multi-Ethnic Study of Atherosclerosis

A Secondary Analysis of a Prospective, Population-Based Cohort
Published:September 14, 2014DOI:



      To evaluate the association of coronary artery calcium (CAC) and coronary heart disease (CHD) events among young and elderly individuals.

      Participants and Methods

      This is a secondary analysis of data from a prospective, multiethnic, population-based cohort study designed to study subclinical atherosclerosis. A total of 6809 persons 45 through 84 years old without known cardiovascular disease at baseline were enrolled from July 2000 through September 2002. All participants had CAC scoring performed and were followed up for a median of 8.5 years. The main outcome measures studied were CHD events, defined as myocardial infarction, definite angina or probable angina followed by revascularization, resuscitated cardiac arrest, or death attributable to CHD.


      Comparing individuals with a CAC score of 0 with those with a CAC score greater than 100, there was an increased incidence of CHD events from 1 to 21 per 1000 person-years and 2 to 23 per 1000 person-years in the 45- through 54-year-old and 75- through 84-year-old groups, respectively. Compared with a CAC score of 0, CAC scores of 1 through 100 and greater than 100 impart an increased multivariable-adjusted CHD event risk in the 45- through 54-year-old and 75- through 84-year-old groups (hazard ratio [HR], 2.3; 95% CI, 0.9-5.8; for those 45-54 years old with CAC scores of 1-100; HR, 12.4; 95% CI, 5.1-30.0; for those 45-54 years old with CAC scores >100: HR, 5.4; 95% CI, 1.2-23.8; for those 75-84 years old with CAC scores of 1-100; and HR, 12.1; 95% CI, 2.9-50.2; for those 75-84 years old with CAC scores >100).


      Increased CAC imparts an increased CHD risk in younger and elderly individuals. CAC is highly predictive of CHD event risk across all age groups, suggesting that once CAC is known chronologic age has less importance. The utility of CAC scoring as a risk-stratification tool extends to both younger and elderly patients.

      Abbreviations and Acronyms:

      CAC (coronary artery calcium), CHD (coronary heart disease), CT (computed tomography), FRS (Framingham Risk Score), HDL-C (high-density lipoprotein cholesterol), MESA (Multi-Ethnic Study of Atherosclerosis)
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        • Taylor A.J.
        • Cerqueira M.
        • Hodgson J.M.
        • et al.
        ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography.
        Circulation. 2010; 122: e525-e555
        • Perk J.
        • De Backer G.
        • Gohlke H.
        • et al.
        European guidelines on cardiovascular disease prevention in clinical practice (version 2012).
        Eur Heart J. 2012; 33: 1635-1701
        • Berry J.D.
        • Lloyd-Jones D.M.
        • Garside D.B.
        • Greenland P.
        Framingham risk score and prediction of coronary heart disease death in young men.
        Am Heart J. 2007; 154: 80-86
        • Elias-Smale S.E.
        • Proença R.V.
        • Koller M.T.
        • et al.
        Coronary calcium score improves classification of coronary heart disease risk in the elderly: the Rotterdam study.
        J Am Coll Cardiol. 2010; 56: 1407-1414
        • Tota-Maharaj R.
        • Blaha M.J.
        • Rivera J.J.
        • et al.
        Differences in coronary plaque composition with aging measured by coronary computed tomography angiography.
        Int J Cardiol. 2012; 158: 240-245
        • Tota-Maharaj R.
        • Blaha M.J.
        • McEvoy J.W.
        • et al.
        Coronary artery calcium for the prediction of mortality in young adults <45 years old and elderly adults >75 years old.
        Eur Heart J. 2012; 33: 2955-2962
        • Raggi P.
        • Gongora M.C.
        • Gopal A.
        • Callister T.Q.
        • Budoff M.
        • Shaw L.J.
        Coronary artery calcium to predict all-cause mortality in elderly men and women.
        J Am Coll Cardiol. 2008; 52: 17-23
        • Newman A.B.
        • Naydeck B.L.
        • Ives D.G.
        • et al.
        Coronary artery calcium, carotid artery wall thickness, and cardiovascular disease outcomes in adults 70 to 99 years old.
        Am J Cardiol. 2008; 101: 186-192
        • LaMonte M.J.
        • FitzGerald S.J.
        • Church T.S.
        • et al.
        Coronary artery calcium score and coronary heart disease events in a large cohort of asymptomatic men and women.
        Am J Epidemiol. 2005; 162: 421-429
        • Villines T.C.
        • Hulten E.A.
        • Shaw L.J.
        • et al.
        • CONFIRM Registry Investigators
        Prevalence and severity of coronary artery disease and adverse events among symptomatic patients with coronary artery calcification scores of zero undergoing coronary computed tomography angiography: results from the CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter) registry.
        J Am Coll Cardiol. 2011; 58: 2533-2540
        • Taylor A.J.
        • Fiorilli P.N.
        • Wu H.
        • et al.
        Relation between the Framingham Risk Score, coronary calcium, and incident coronary heart disease among low-risk men.
        Am J Cardiol. 2010; 106: 47-50
        • Bild D.E.
        • Bluemke D.A.
        • Burke G.L.
        • et al.
        Multi-Ethnic Study of Atherosclerosis: objectives and design.
        Am J Epidemiol. 2002; 156: 871-881
        • Carr J.J.
        • Nelson J.C.
        • Wong N.D.
        • et al.
        Calcified coronary artery plaque measurement with cardiac CT in population-based studies: standardized protocol of Multi-Ethnic Study of Atherosclerosis (MESA) and Coronary Artery Risk Development in Young Adults (CARDIA) study.
        Radiology. 2005; 234: 35-43
        • Agatston A.S.
        • Janowitz W.R.
        • Hildner F.J.
        • Zusmer N.R.
        • Viamonte Jr., M.
        • Detrano R.
        Quantification of coronary artery calcium using ultrafast computed tomography.
        J Am Coll Cardiol. 1990; 15: 827-832
        • Yoon S.S.
        • Burt V.
        • Louis T.
        • Carroll M.D.
        Hypertension Among Adults in the United States, 2009-2010.
        National Center for Health Statistics, Hyattsville, MD2012 (NCHS Data Brief 107)
        • Centers for Disease Control and Prevention
        National Diabetes Fact Sheet: National Estimates and General Information on Diabetes and Prediabetes in the United States, 2011.
        US Dept of Health and Human Services, Centers for Disease Control and Prevention, Atlanta, GA2011
        • Centers for Disease Control and Prevention
        Vital signs: current cigarette smoking among adults aged ≥ 18 years—United States, 2005–2010.
        MMWR Morb Mortal Wkly Rep. 2011; 60: 1207-1212
        • Nasir K.
        • Rubin J.
        • Blaha M.J.
        • et al.
        Interplay of coronary artery calcification and traditional risk factors for the prediction of all-cause mortality in asymptomatic individuals.
        Circ Cardiovasc Imaging. 2012; 5: 467-473
        • Vliegenthart R.
        • Oudkerk M.
        • Hofman A.
        • et al.
        Coronary calcification improves cardiovascular risk prediction in the elderly.
        Circulation. 2005; 112: 572-577
        • Blaha M.
        • Budoff M.J.
        • Shaw L.J.
        • et al.
        Absence of coronary artery calcification and all-cause mortality.
        JACC Cardiovasc Imaging. 2009; 2: 692-700
        • Goff Jr., D.C.
        • Lloyd-Jones D.M.
        • Bennett G.
        • et al.
        2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.
        Circulation. 2014; 129: S49-S73
        • Stone N.J.
        • Robinson J.
        • Lichtenstein A.H.
        • et al.
        2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.
        Circulation. 2014; 129: S1-S45
        • Ridker P.M.
        • Cook N.R.
        Statins. New American guidelines for prevention of cardiovascular disease.
        Lancet. 2013; 382: 1762-1765
        • Budoff M.J.
        • Nasir K.
        • McClelland R.L.
        • et al.
        Coronary calcium predicts events better with absolute calcium scores than age-sex-race/ethnicity percentiles: MESA (Multi-Ethnic Study of Atherosclerosis).
        J Am Coll Cardiol. 2009; 53: 345-352