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Observational Study
. 2015 Jan;8(1):e002262.
doi: 10.1161/CIRCIMAGING.114.002262.

Comparison of coronary artery calcium presence, carotid plaque presence, and carotid intima-media thickness for cardiovascular disease prediction in the Multi-Ethnic Study of Atherosclerosis

Adam D Gepner  1 , Rebekah Young  1 , Joseph A Delaney  1 , Matthew C Tattersall  1 , Michael J Blaha  1 , Wendy S Post  1 , Rebecca F Gottesman  1 , Richard Kronmal  1 , Matthew J Budoff  1 , Gregory L Burke  1 , Aaron R Folsom  1 , Kiang Liu  1 , Joel Kaufman  1 , James H Stein  2
Affiliations
Observational Study

Comparison of coronary artery calcium presence, carotid plaque presence, and carotid intima-media thickness for cardiovascular disease prediction in the Multi-Ethnic Study of Atherosclerosis

Adam D Gepner et al. Circ Cardiovasc Imaging. 2015 Jan.

Abstract

Background: Presence of coronary artery calcium (CAC), carotid plaque, and increased carotid intima-media thickness (IMT) may indicate elevated cardiovascular disease (CVD) risk; however, no large studies have compared them directly. This study compares predictive uses of CAC presence, carotid artery plaque presence, and high IMT for incident CVD events.

Methods and results: Participants were from the Multi-Ethnic Study of Atherosclerosis (MESA). Predictive values of carotid plaque, IMT, and CAC presence were compared using Cox proportional hazards models, c-statistics, and net reclassification indices. The 6779 participants were mean (SD) 62.2 (10.2) years old; 49.9% had CAC, and 46.7% had carotid plaque. The mean left and right IMT were 0.754 (0.210) mm and 0.751 (0.187) mm, respectively. After 9.5 years (mean), 538 CVD events, 388 coronary heart disease (CHD) events, and 196 stroke/transient ischemic attacks were observed. CAC presence was a stronger predictor of incident CVD and CHD than carotid ultrasound measures. Mean IMT≥75th percentile (for age, sex, and race) alone did not predict events. Compared with traditional risk factors, c-statistics for CVD (c=0.756) and CHD (c=0.752) increased the most by the addition of CAC presence (CVD, 0.776; CHD, 0.784; P<0.001) followed by carotid plaque presence (CVD, c=0.760; CHD, c=0.757; P<0.05). Compared with risk factors (c=0.782), carotid plaque presence (c=0.787; P=0.045) but not CAC (c=0.785; P=0.438) improved prediction of stroke/transient ischemic attacks.

Conclusions: In adults without CVD, CAC presence improves prediction of CVD and CHD more than carotid plaque presence or high IMT. CAC and carotid ultrasound parameters performed similarly for stroke/transient ischemic attack event prediction.

Keywords: atherosclerosis; cardiovascular disease; carotid arteries; neuroimaging; risk factors.

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Figures

Figure
Figure. Summary of Risk Factor Adjusted Cox Regression Models for Predicting Incident Events, MESA
Multivariable models with multiple imputation adjusted for age, gender, race/ethnicity, education, income, heart rate, body mass index, smoking, total cholesterols, high-density lipoprotein cholesterol, lipid-lowering medication use, diabetes mellitus status, systolic blood pressure and anti-hypertensive medication use. Sample size = 6,779. Abbreviations as in Table 1: CI = confidence interval; carotid plaque/CIMT75 = composite of any carotid plaque presence or CCA IMT ≥ 75th percentile
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