scholarly journals Sex differences in coronary artery calcium progression: The Korea Initiatives on Coronary Artery Calcification (KOICA) registry

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0248884
Author(s):  
Wonjae Lee ◽  
Yeonyee E. Yoon ◽  
Sang-Young Cho ◽  
In-Chang Hwang ◽  
Sun-Hwa Kim ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Calcium ◽  
Risk Group ◽  
Multivariable Analysis ◽  
Low Risk ◽  
Progression Rate ◽  
Atherosclerotic Cardiovascular Disease ◽  
Ascvd Risk ◽  
Male Sex

Even with increasing awareness of sex-related differences in atherosclerotic cardiovascular disease (ASCVD), it remains unclear whether the progression of coronary atherosclerosis differs between women and men. We sought to compare coronary artery calcium (CAC) progression between women and men. From a retrospective, multicentre registry of consecutive asymptomatic individuals who underwent CAC scoring, we identified 9,675 men and 1,709 women with follow-up CAC scoring. At baseline, men were more likely to have a CAC score >0 than were women (47.8% vs. 28.6%). The probability of CAC progression at 5 years, defined as [√CAC score (follow-up)—√CAC score (baseline)] ≥2.5, was 47.4% in men and 29.7% in women (p<0.001). When we stratified subjects according to the 10-year ASCVD risk (<5%, ≥5% and <7.5%, and ≥7.5%), a sex difference was observed in the low risk group (CAC progression at 5 years, 37.6% versus 17.9%; p<0.001). However, it became weaker as the 10-year ASCVD risk increased (64.2% versus 46.2%; p<0.001, and 74.8% versus 68.7%; p = 0.090). Multivariable analysis demonstrated that male sex was independently associated with CAC progression rate among the entire group (p<0.001). Subgroup analyses showed an independent association between male sex and CAC progression rate only in the low-risk group. The CAC progression rate is higher in men than in women. However, the difference between women and men diminishes as the 10-year ASCVD risk increases.

Abstract 13298: The Association Between Coronary Artery Calcium and Atherosclerotic Cardiovascular Disease Risk in Women With Early Menopause: The Multi-Ethnic Study of Atherosclerosis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jian Chu ◽  
Erin D Michos ◽  
Pamela Ouyang ◽  
Dhananjay Vaidya ◽  
Roger S Blumenthal ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Coronary Artery ◽  
Postmenopausal Women ◽  
Coronary Artery Calcium ◽  
Atherosclerotic Cardiovascular Disease ◽  
Early Menopause ◽  
Ethnic Study ◽  
Ascvd Risk

Background: Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of mortality among women, and early menopause (EM) is associated with an increased risk for ASCVD. Coronary artery calcium (CAC) is a non-invasive measurement of an individual’s subclinical atherosclerotic burden that is used to refine ASCVD risk estimation, and the absence of CAC is a robust predictor of low 10-year ASCVD risk. However, it is unknown whether there is a difference in the long-term association between the absence of CAC and ASCVD risk between women with and without EM. Objectives: To compare the prevalence of CAC and its association with incident ASCVD between women with and without EM. Methods: We performed Kaplan-Meier survival analysis and multivariable Cox proportional hazards modeling using data from 2,456 postmenopausal women in the Multi-Ethnic Study of Atherosclerosis (MESA) with or without EM, defined as occurring at <45 years of age. Results: Participants had a mean age of 64.1 years, 39% were White, and 28% (n=688) experienced EM. There were 291 ASCVD events over a mean follow-up of 12.5 years. Women with EM had a slightly lower prevalence of CAC=0 (55.1%) than women without EM (59.7%) (p=0.04) despite no difference in mean age. Among women with CAC=0, the cumulative incidence of ASCVD was slightly higher at 10-year follow-up for women with vs. without EM (5.4% vs. 3.2%, p=0.06) and significantly higher at 15-years (11.4% vs. 6.4%, p<0.01) (Figure). In multivariable Cox models, compared to women with CAC=0, those with CAC 1-99 and ≥100 had progressively increased ASCVD risk that did not significantly differ by EM status. Conclusions: More than half of postmenopausal women with EM had CAC=0 and an associated low-to-borderline 10-year risk of ASCVD. When CAC>0, the risk of ASCVD was similar for women with and without EM. Additional research is needed to better understand very long-term differences in ASCVD risk between women with and without EM who have CAC=0.

Evaluating the sensitivity of the ACC/AHA pooled cohort risk calculator to predict atherosclerotic cardiovascular events within 10 years: how many events are we failing to predict?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Medina-Inojosa ◽  
V.K Somers ◽  
S Hayes ◽  
R Mankad ◽  
F Lopez-Jimenez
Keyword(s):  
Cardiovascular Risk ◽  
Cardiovascular Health ◽  
Fasting Blood Glucose ◽  
Low Risk ◽  
P Value ◽  
Funding Source ◽  
Atherosclerotic Cardiovascular Disease ◽  
Ideal Cardiovascular Health ◽  
Ascvd Risk

Abstract Background The ACC/AHA Pooled Cohort Equation (PCE) for atherosclerotic cardiovascular disease (ASCVD) has been recommended as the initial step in cardiovascular risk assessment. The sensitivity of this tool to detect those who will develop ASCVD within 10-years, while considering age and sex groups, has not been extensively studied. Methods Using the Rochester Epidemiology Project (REP) we evaluated a community-based cohort of consecutive patients that sought primary care in Olmsted County, MN, between the years 1998–2000 and were followed up through March 1st 2016. Inclusion criteria were ages 40–79 and complete data to calculate the PCE. We excluded those with known ASCVD, atrial fibrillation or heart failure. Criteria were similar to those used to derive the PCE. Events were validated in duplicate and included fatal and non-fatal myocardial infarction and ischemic stroke. Patient information was ascertained using the record linkage system of the REP. Follow-up was truncated at 10 years. We assessed the ASCVD predicted risk (categorized as low &lt;5%, intermediate 5–9.9%, high 10–19.9%, and very high ≥20% risk) at baseline, in subjects having an ASCVD event within 10-years in the community across age (&lt;65 years) and sex categories. We also categorized ideal cardiovascular health as ≥4 metrics [non-smoker, body mass index &lt;25 kg/m2, and not having of elevated blood pressure (≥130/80 mmHg), LDL cholesterol (&gt;100 mg/dL), or fasting blood glucose (&gt;100 mg/dL), in the absence of a medical diagnosis or treatment]. Results We included 30,042 adults, mean ± SD age 48.5±12.2 years, 54% women, with a median follow-up of 16.5±5.3 years. There were 1,555 ASCVD events (5.2%) at 10 years of follow-up. The performance of the PCE was similar to what was described in the original report (0.78 vs 0.79). Overall, among those who suffered an ASCVD, 54% of women and 41% of men were not high risk as predicted by PCE (Figure 1A). Most women (73%) &lt;65 years of age would had been considered low risk within 10-years before the event, and only 10% would have been considered to be high risks (Figure 1B). Nonetheless, women &lt;65 years who had an ASCVD event and low 10-year predicted ASCVD risk by PCE were less likely to have ideal cardiovascular health [55 (0.40%) vs 3884 (28.39%), p-value&lt;0.0001], when compared to women in the low risk category without an event. Conclusion The PCE fails to identify most women who will develop an ASCVD event, particularly women &lt;65 years of age. These results underscore the importance of using additional information when estimating ASCVD risk among women and the need for better cardiovascular risk prediction tools. Figure 1 Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Mayo Clinic

Abstract 16890: Coronary Artery Calcium for Personalizing Antihypertensive Therapy: A Pooled Cohort Analysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Gargya Malla ◽  
Vibhu Parcha ◽  
Rajat Kalra ◽  
Ambarish Pandey ◽  
Nasir Khurram ◽  
...  
Keyword(s):  
Coronary Artery ◽  
High Risk ◽  
Coronary Artery Calcium ◽  
Proportional Hazards ◽  
Cohort Analysis ◽  
Cox Proportional Hazards ◽  
Low Risk ◽  
Number Needed To Treat ◽  
Atherosclerotic Cardiovascular Disease ◽  
Stage 1

Background: The 2017 American College of Cardiology/American Heart Association high blood pressure (BP) guidelines recommend risk assessment of atherosclerotic cardiovascular disease (CVD) to inform hypertension (HTN) treatment in adults with elevated BP or low-risk stage 1 HTN. Use of coronary artery calcium (CAC) score, an excellent imaging risk-prediction tool, to guide HTN therapy has not been well studied. Methods: Participants free of CVD were pooled from three population cohort studies; 1) Multiethnic Study of Atherosclerosis, 2) Coronary Artery Risk Development in Young Adults and 3) Jackson Heart Study. Risk for incident CVD events (heart failure, stroke or cardiovascular mortality) by the CAC status and the BP treatment group was assessed. Multivariable Cox proportional hazards models were used to estimate the hazard ratios. The 10-year number needed to treat to prevent a single CVD event was also estimated. Results: This study included 11,499 participants (mean age 56 years; 55.2% women; 42.1% blacks). CAC score was non-zero in 38.2% of the participants. Over a median follow-up of 8.5 years, 910 incident CVD events occurred. Compared to those with zero CAC, participants with non-zero CAC score had a higher CVD incidence rate (per 1000 person-years) at all BP levels (elevated BP/low-risk stage 1 HTN: 14.5 vs 2.7; high-risk stage 1 or stage 2 HTN: 27.1 vs 8.8). Multivariable adjusted hazards of adverse CVD events displayed similar patterns ( Figure ). Among those with zero CAC, the 10-year number needed to treat to prevent 1 CVD event was 154 for those with elevated BP/low-risk stage 1 HTN and 47 for those with high-risk stage 1 or stage 2 HTN. Among those with non-zero CAC score, the number needed to treat was lower, 33 and 18 respectively. Conclusions: Utilization of CAC score may be an effective precision medicine approach to personalize HTN therapy in elevated BP or low-risk stage 1 HTN when treatment is not recommended by the current guidelines.

Abstract 16212: Warranty Period of Zero Coronary Artery Calcium Score in Asymptomatic Korean Individuals

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Ji-hyun Lee ◽  
Dong-hee Han ◽  
Bríain ó Hartaigh ◽  
Heidi Gransar ◽  
Su-Yeon Choi ◽  
...  
Keyword(s):  
Risk Factor ◽  
Coronary Artery ◽  
Coronary Artery Calcium ◽  
Cox Regression ◽  
Calcium Score ◽  
Cardiac Risk ◽  
Low Risk ◽  
Warranty Period ◽  
Hazard Ratios

Introduction: Zero coronary artery calcium (CAC) is a reliable predictor of absent atherosclerosis and serves as a useful adjunct for identifying those at low risk. Despite this, the “warranty period” that displays the protective value associated with the absence of CAC towards experiencing a cardiovascular event among Asians is not well established. Hypothesis: To examine whether the absence of CAC displays a more favorable warranty period for all-cause death compared with the presence of CAC in a Korean cohort. Methods: A total of 48,215 asymptomatic Koreans (mean age: 54±8.8 years; 25% women) were enrolled and stratified by the absence or presence of CAC. Time to exceeding 1% of cumulative all-cause death was estimated in order to identify low-risk individuals. Hazard ratios (HR) with 95% confidence intervals (95% CI) for all-cause death were estimated according to prespecified cardiac risk factors and the presence of CAC. Results: In total, 30,605 (63.5%) individuals presented with a zero CAC. Across a median follow-up of 4.4 years (Interquartile range: 2.7-6.6 years), 415 (0.9%) individuals experienced the endpoint of all-cause death. For those with a zero CAC, the time to exceeding 1% risk was found to be 9 years, indicating a substantially longer warranty period compared with participants with a CAC>0 (e.g., 5 year warranty period). The time to exceeding 1% risk tended to decline for individuals on the background of increasing CAC scores. For each of the other prespecified risk factor groups, a zero CAC provided a longer cumulative event free period than in the presence of any CAC. Cox regression analyses also revealed that the absence of CAC was independently associated with a lower risk of all-cause death in each of the respective risk factor groups when compared with CAC>0. Conclusions: In a large cohort of asymptomatic Korean individuals, the absence of CAC evokes a strong protective effect against all-cause death as demonstrated by a longer warranty period.

Abstract 163: Association of Diabetes With Coronary Artery Calcium in South Asians, African Americans, Caucasians, Chinese, and Hispanics: The Multi-Ethnic Study of Atherosclerosis (MESA) and the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ned Premyodhin ◽  
Wenjun Fan ◽  
Millie Arora ◽  
Masood Younus ◽  
Matthew J Budoff ◽  
...  
Keyword(s):  
Coronary Artery ◽  
African Americans ◽  
Ethnic Groups ◽  
Coronary Artery Calcium ◽  
South Asians ◽  
Subclinical Atherosclerosis ◽  
Study Cohort ◽  
Atherosclerotic Cardiovascular Disease ◽  
Normal Glucose

Introduction: South Asians (SA) have increased atherosclerotic cardiovascular disease (ASCVD) risk and SA ethnicity is considered a “risk-enhancing factor” in the latest prevention guidelines. Diabetes mellitus (DM) is common in SA, but it is not known how pre-DM or DM may contribute to subclinical atherosclerosis in SA compared to other ethnic groups. We examined the association of pre-DM and DM to coronary artery calcium (CAC) in SA compared to 4 other ethnic groups. Methods: We studied data from SA, African Americans (AA), non-Hispanic whites (NHW), Chinese (CH), and Hispanics (HS) aged 45-84 without known ASCVD. SA were taken exclusively from MASALA and other groups from MESA. The prevalence of CAC 0, 1-99, 100-399, and 400+ were examined among those who were normoglycemic, pre-DM and DM. Multiple logistic regression adjusted for age, sex, smoking, cholesterol, and blood pressure identified the associations of pre-DM and DM (compared to normal glucose) on the odds of any CAC > 0 and significant CAC ≥ 100 by ethnicity. Results: Of the 7587 included individuals, mean age was 62±10 years, with 48% men, 10% SA, 25% AA, 34% NHW, 11% CH and 20% HS. The prevalence of pre-DM and DM varied significantly (p < 0.01) across ethnic groups: SA (25% and 21%), AA (15% and 18%), NHW (11% and 6%), CH (17% and 13%) and HS (15% and 17%). The prevalence of any CAC and CAC ≥ 100 in those with DM were highest in NHW (80% and 48%) and SA (72% and 41%). Pre-DM was only associated with CAC ≥ 100 in NHW (OR = 1.5, p < 0.01). Compared to other groups, SA with DM (compared to those normoglycemic) had the highest odds ratios (ORs) for CAC > 0 (OR = 3.35, p < 0.01) and CAC ≥ 100 (OR = 3.10, p < 0.01) (p = 0.01 and 0.07 for ethnicity interactions, respectively) (Table). Conclusions: Diabetes was associated with higher odds of any or significant CAC among SA compared to other ethnic groups. Ongoing longitudinal follow-up of the MASALA study cohort might help explain if DM contributes to the often premature ASCVD outcomes in SA.

Thrombotic Events in Lupus Anticoagulant Positive Patients Prospectively Correlate with Clinical Risk Factors - the Vienna Lupus Anticoagulant and Thrombosis Study (LATS)

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 652-652
Author(s):  
Florian Posch ◽  
Johanna Gebhart ◽  
Jacob H. Rand ◽  
Bas de Laat ◽  
Silvia Koder ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lupus Anticoagulant ◽  
Risk Group ◽  
Multivariable Analysis ◽  
Low Risk ◽  
Active Smoking ◽  
Thrombotic Risk ◽  
Glycoprotein I ◽  
Prolonged Aptt

Abstract INTRODUCTION: Patients with the lupus anticoagulant (LA) are at an increased risk of thrombotic events (TE), which in turn increase the risk of death (Gebhart J et al. Blood. 2015. 125:3477). Understanding the determinants of thrombotic risk in LA patients may pave the way towards targeted thromboprophylaxis. To date, several retrospective studies have investigated the association between anamnestic thrombosis and certain factors, such as antibodies against cardiolipin and beta2-glycoprotein I. However, robust prospective evidence is still limited. We aimed to investigate clinical and laboratory risk factors for development of TE in patients with a persistently positive LA. PATIENTS & METHODS: In this prospective, observational cohort study with a baseline biobank we followed 150 patients (median age: 41.3 years, interquartile range (IQR): 32.3-60.2, female gender: n=122 (81.3%)), who tested repeatedly positive for the LA until the development of TE, death, or censoring. The primary endpoint was the time-to-TE during the observation period, defined as a composite of arterial or venous, independently-adjudicated thrombotic complications. Ninety-eight (65.3%) of the 150 patients had a history of at least one TE event (arterial TE: n=21, venous TE: n=84, both: n=7), and 70 (46.7%) were on oral anticoagulation at baseline. Sixty-five (43.3%) patients also had IgM and/or IgG isotype antibodies against cardiolipin and beta2-glycoprotein I ("Triple positivity"). For investigation of the LA, lupus-sensitive aPTT reagents were used (aPTT-LA, Diagnostica Stago, Asnieres, France). Prospective associations were analyzed using competing risk analysis treating death-from-any-cause as the competing event. Evaluated risk factors included (1) the lupus-sensitive activated partial thromboplastin time (aPTT-LA), (2) antibodies against cardiolipin, beta2-glycoprotein I, domain 1 of beta2-glycoprotein I, prothrombin, and "triple positivity", (3) general cardiovascular risk factors (diabetes, hypertension, smoking, and hypertriglyceridemia, body mass index), and (4) AnnexinA5 resistance (A5R). RESULTS: During a median follow-up period of 8.7 years (range: 12 days - 12.4 years), 30 TE events occurred (arterial TE: n=14, venous TE: n=16), and 20 patients died. The cumulative incidence of TE at 1, 5, and 10 years of follow-up were 4.0% (95% Confidence Interval (CI): 1.7-8.1), 12.8% (95% CI: 7.9-18.9), and 24.4% (95% CI: 16.8-32.8), respectively. In univariable analysis, a prolonged aPTT-LA (Subhazard ratio (SHR) for aPTT≥118 seconds (i.e. 75th percentile of the aPTT-LA distribution)=2.59, 95%CI: 1.27-5.31, p=0.009), diabetes (SHR=4.36, 95%CI: 1.44-13.19, p=0.009), active smoking (SHR=2.35, 95%CI: 1.16-4.77, p=0.018), and elevated triglycerides (SHR per 50mg/dL increase=1.14, 95%CI: 1.09-1.18, p<0.001) were associated with a higher risk of TE events. In multivariable analysis, the only independent predictors of a higher thrombotic risk were a prolonged aPTT-LA (adjusted SHR=2.33, 95%CI: 1.06-5.13, p=0.035), diabetes (adjusted SHR=3.79, 95%CI: 1.12-12.89, p=0.033), and active smoking (adjusted SHR=2.62, 95%CI: 1.24-5.52, p=0.012). These results prevailed after adjusting for anticoagulation at baseline. Using these three parameters allowed identification of clinical subgroups with a very high and a low risk of TE events (cumulative risk of TE after 5 years 43.3% in the high risk group and 5.6% in the low risk group, respectively, Figure 1). The other risk factors did neither in univariable nor in multivariable analysis emerge as predictors of thrombotic risk in this large cohort. CONCLUSION: Diabetes and smoking, which are established risk factors for vascular events in the general population, turned out to be relevant also in patients with the LA. Moreover, a very long lupus sensitive aPTT was as well predictive for occurrence of TE in these patients. This effect was independent of anticoagulation. Interestingly, disease defining antibodies, such as those against cardiolipin or beta2-glycoprotein I (including those against domain I) were not associated with future occurrence of TE in this LA positive patient population. These data suggest that above standard anticoagulation, interventions to control and improve metabolic status and smoking habits might influence the rates of future TE in patients with known persistent LA. Disclosures No relevant conflicts of interest to declare.

Abstract 13514: Gender-Stratified Difference in the Association Between Coronary Artery Calcium and Incident Peripheral Artery Disease: The Multi-Ethnic Study of Atherosclerosis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Hooman Bakhshi ◽  
PRAMITA BAGCHI ◽  
Zahra Meyghani ◽  
Behnam N Tehrani ◽  
Parveen K Garg ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Coronary Artery ◽  
Peripheral Artery Disease ◽  
Coronary Artery Calcium ◽  
Multivariable Analysis ◽  
Traditional Cardiovascular Risk Factor ◽  
Peripheral Artery ◽  
Ethnic Study ◽  
Artery Disease

Introduction: Coronary artery calcium score (CACs) measured by non-contrast cardiac CT has a strong correlation with coronary atherosclerotic burden. Although CACs predicts incident coronary heart disease, its gender-specific association with incident peripheral artery disease (PAD) is not clear. Methods: The multi-ethnic study of atherosclerosis (MESA) is a prospective population-based cohort consisting of 6814 men and female free of overt cardiovascular disease at enrollment. In this study we included MESA participants with baseline CACs and at least one ankle brachial index (ABI) measured at follow up exams. We excluded participants with baseline ABI≤ 0.9 or> 1.4. Incident PAD was defined as a follow up ABI≤ 0.9 and decline of ≥15%. Multivariable logistic regression models were deployed to evaluate the association between baseline CACs and incident PAD in female and male. Results: The mean age (SD) was 61.29 (9.96) years and 52.6% (3013/5725) were female. Female had lower baseline ABI [1.10 (0.08) vs 1.15 (0.09); p < 0.001]. Over a median (IQR) of 9.23 (8.22-9.60) years, 113(4%) female and 85(3%) male developed PAD. Every one unit increase in log (CACs+1) was associated with 1.11-fold higher odds of incident PAD in male (p=0.001). This association remained significant after adjustment for demographics, traditional cardiovascular risk factor and baseline ABI. Male participants with CACs>300 showed 1.94-fold higher odds of incident PAD compared to participant with CACs=0 (p=0.005). In female there was no statistically significant association between CACs and incident PAD in multivariable analysis. Conclusions: Baseline CACs is associated with future PAD independent of traditional cardiovascular risk factors in male participants of a multi-ethnic cohort. Disclaimer statement: The views expressed in this abstract are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute; the National Institutes of Health; or the U.S. Department of Health and Human Services.

Abstract P318: Risk factors for 10-year coronary artery calcium progression in the Multi-Ethnic Study of Atherosclerosis

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Amanda J Gassett ◽  
Lianne Sheppard ◽  
Robyn L McClelland ◽  
Richard A Kronmal ◽  
Matthew J Budoff ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery ◽  
Coronary Artery Calcium ◽  
Causal Effect ◽  
Progression Rate ◽  
Clinical Events ◽  
Coronary Events ◽  
Simultaneous Adjustment ◽  
The Relationship

Coronary artery calcium (CAC) progression has previously been observed to predict coronary events above and beyond its association with baseline CAC. Prior studies show associations between CAC progression and risk factors, but were limited by short follow-up or restriction to individuals with advanced disease. We examined the relationship between risk factors for clinical events and the progression of CAC in MESA, a prospective cohort study. Participants were 6810 adults without CVD at recruitment in 2000-2002. Agatston scores for extent of calcification were assessed 1-4 times (mean 2.5) over a 10-year period with interim exams spaced at approximately 2-4 years. Mean follow-up time for those with at least 2 scans was 5.0 years. An innovative approach to mixed effects models jointly modeled the associations between risk factors and CAC both at baseline and with CAC progression rate. This method is less biased than controlling for baseline CAC, since the same risk factors are associated with both baseline and progression. Hence, time-varying factors can adjust progression rate, and data from participants with varying follow-up time and number of measurements_even those measured only at baseline_are incorporated. Mean CAC progression rate was 25 CAC units/year. All models were adjusted for age, sex, site, and race/ethnicity. Strong effects were observed for age, male sex, hypertension, and diabetes. Effects for statins likely reflect poor health status, rather than a causal effect of medication. Simultaneous adjustment for all risk factors produced similar results except the effect of statin use was not observed. See table for estimates and confidence intervals. In conclusion, CAC progression is associated with risk factors for clinical coronary events, confirming that processes involved in CAC progression mirror development of clinical atherosclerosis. The methods applied for the analysis of repeated continuous noninvasive measures of atherosclerosis extent can also be applied to evaluating novel risk factors.

Impact of age and sex on subclinical coronary atherosclerosis in a healthy asian population

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
M Wong ◽  
J Yap ◽  
KK Yeo
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Coronary Artery ◽  
Coronary Atherosclerosis ◽  
Ldl Cholesterol ◽  
Multivariable Analysis ◽  
Asian Population ◽  
Atherosclerotic Cardiovascular Disease ◽  
Age And Gender ◽  
And Gender

Abstract Funding Acknowledgements Type of funding sources: None. Background and Aims The influence of age and gender on clinical atherosclerotic cardiovascular disease is well reported, but literature remains sparse on whether these extend to the disease in its preclinical stage. We aim to report the prevalence, risk-factors and impact of age and gender on the burden of subclinical coronary atherosclerosis in a healthy Asian population. Methods Healthy subjects aged 30-69 years old, with no history of cardiovascular disease or diabetes were recruited from the general population. Subclinical coronary atherosclerosis was quantified via the Coronary Artery Calcium Score (CACS) with CACS of 0 indicating the absence of calcified plaque, 1 to 10 minimal plaque, 11 to 100 mild plaque, and &gt;100 moderate to severe plaque. Results A total of 663 individuals (mean age 49.4 ± 9.2 years, 44.8% male) were included. The prevalence of any CAC was 29.3% with 9% having CAC &gt; 100.  The prevalence was significantly higher in males than females (43.1 vs 18.0%, p &lt; 0.001). These gender differences became increasingly pronounced with increasing age, especially in those with moderate-severe CAC. Multivariable analysis revealed significant associations between increasing age, male, higher blood pressure, increased glucose levels and higher LDL cholesterol levels with the presence of any CAC. LDL cholesterol was more significantly associated with CAC in females compared to males (Pinteraction = 0.022). Conclusions The prevalence of preclinical atherosclerosis increased with age, and was higher in males than females, with gender-specific differences in associated risk factors. These results will better inform individualised future risk management strategies to prevent the development and progression of coronary artery disease within healthy individuals.

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