TY - JOUR
T1 - Discordance Between Coronary Artery Calcium Area and Density Predicts Long-Term Atherosclerotic Cardiovascular Disease Risk
AU - Razavi, Alexander C.
AU - van Assen, Marly
AU - De Cecco, Carlo N.
AU - Dardari, Zeina A.
AU - Berman, Daniel S.
AU - Budoff, Matthew J.
AU - Miedema, Michael D.
AU - Nasir, Khurram
AU - Rozanski, Alan
AU - Rumberger, John A.
AU - Shaw, Leslee J.
AU - Sperling, Laurence S.
AU - Whelton, Seamus P.
AU - Mortensen, Martin Bødtker
AU - Blaha, Michael J.
AU - Dzaye, Omar
N1 - Publisher Copyright:
© 2022 American College of Cardiology Foundation
PY - 2022/11
Y1 - 2022/11
N2 - Background: Coronary artery calcium (CAC) is commonly quantified as the product of 2 generally correlated measures: plaque area and calcium density. Objectives: The authors sought to determine whether discordance between calcium area and density has long-term prognostic importance in atherosclerotic cardiovascular disease (ASCVD) risk. Methods: The authors studied 10,373 primary prevention participants from the CAC Consortium with CAC >0. Based on their median values, calcium area and mean calcium density were divided into 4 mutually exclusive concordant/discordant groups. Cox proportional hazards regression assessed the association of calcium area/density groups with ASCVD mortality over a median of 11.7 years, adjusting for traditional risk factors and the Agatston CAC score. Results: The mean age was 56.7 years, and 24% were female. The prevalence of plaque discordance was 19% (9% low calcium area/high calcium density, 10% high calcium area/low calcium density). Female sex (odds ratio [OR]: 1.48 [95% CI: 1.27-1.74]) and body mass index (OR: 0.81 [95% CI: 0.76-0.87], per 5 kg/m2 higher) were significantly associated with high calcium density discordance, whereas diabetes (OR: 2.23 [95% CI: 1.85-3.19]) was most strongly associated with discordantly low calcium density. Compared to those with low calcium area/low calcium density, individuals with low calcium area/high calcium density had a 71% lower risk of ASCVD death (HR: 0.29 [95% CI: 0.09-0.95]). Conclusions: For a given CAC score, high calcium density relative to plaque area confers lower long-term ASCVD risk, likely serving as an imaging marker of biological resilience for lesion vulnerability. Additional research is needed to define a robust definition of calcium area/density discordance for routine clinical risk prediction.
AB - Background: Coronary artery calcium (CAC) is commonly quantified as the product of 2 generally correlated measures: plaque area and calcium density. Objectives: The authors sought to determine whether discordance between calcium area and density has long-term prognostic importance in atherosclerotic cardiovascular disease (ASCVD) risk. Methods: The authors studied 10,373 primary prevention participants from the CAC Consortium with CAC >0. Based on their median values, calcium area and mean calcium density were divided into 4 mutually exclusive concordant/discordant groups. Cox proportional hazards regression assessed the association of calcium area/density groups with ASCVD mortality over a median of 11.7 years, adjusting for traditional risk factors and the Agatston CAC score. Results: The mean age was 56.7 years, and 24% were female. The prevalence of plaque discordance was 19% (9% low calcium area/high calcium density, 10% high calcium area/low calcium density). Female sex (odds ratio [OR]: 1.48 [95% CI: 1.27-1.74]) and body mass index (OR: 0.81 [95% CI: 0.76-0.87], per 5 kg/m2 higher) were significantly associated with high calcium density discordance, whereas diabetes (OR: 2.23 [95% CI: 1.85-3.19]) was most strongly associated with discordantly low calcium density. Compared to those with low calcium area/low calcium density, individuals with low calcium area/high calcium density had a 71% lower risk of ASCVD death (HR: 0.29 [95% CI: 0.09-0.95]). Conclusions: For a given CAC score, high calcium density relative to plaque area confers lower long-term ASCVD risk, likely serving as an imaging marker of biological resilience for lesion vulnerability. Additional research is needed to define a robust definition of calcium area/density discordance for routine clinical risk prediction.
KW - calcium density
KW - cardiovascular diseases
KW - coronary artery calcium
KW - multidetector computed tomography
UR - http://www.scopus.com/inward/record.url?scp=85136720434&partnerID=8YFLogxK
U2 - 10.1016/j.jcmg.2022.06.007
DO - 10.1016/j.jcmg.2022.06.007
M3 - Article
C2 - 35850937
AN - SCOPUS:85136720434
SN - 1936-878X
VL - 15
SP - 1929
EP - 1940
JO - JACC: Cardiovascular Imaging
JF - JACC: Cardiovascular Imaging
IS - 11
ER -