Coronary artery calcification compared with carotid intima-media thickness in the prediction of cardiovascular disease incidence - The Multi-Ethnic Study of Atherosclerosis (MESA)

被引：573

作者：

Folsom, Aaron R. ^{[1
]}

Kronmal, Richard A. ^{[2
]}

Detrano, Robert C. ^{[3
]}

O'Leary, Daniel H. ^{[4
]}

Bild, Diane E. ^{[5
]}

Bluemke, David A. ^{[6
]}

Budoff, Matthew J. ^{[8
]}

Liu, Kiang ^{[9
]}

Shea, Steven ^{[10
,11
]}

Szklo, Moyses ^{[7
]}

Tracy, Russell P. ^{[12
,13
]}

Watson, Karol E. ^{[14
]}

Burke, Gregory L. ^{[15
]}

机构：

[1] Univ Minnesota, Sch Publ Hlth, Div Epidemiol & Community Hlth, Minneapolis, MN 55454 USA

[2] Univ Washington, Collaborat Hlth Studies Coordinating Ctr, Seattle, WA 98195 USA

[3] Univ Calif Irvine, Dept Radiol Sci, Irvine, CA 92717 USA

[4] Caritas Carney Hosp, Dorchester, MA USA

[5] NHLBI, Div Prevent & Populat Sci, Bethesda, MD 20892 USA

[6] Johns Hopkins Univ, Sch Med, Dept Radiol, Baltimore, MD 21205 USA

[7] Johns Hopkins Univ, Sch Med, Dept Epidemiol, Baltimore, MD USA

[8] Univ Calif Los Angeles, Med Ctr, Los Angeles Biomed Res Inst Harbor, Div Cardiol, Torrance, CA 90509 USA

[9] Northwestern Univ, Sch Med, Dept Prevent Med, Chicago, IL USA

[10] Columbia Univ, Dept Med, New York, NY USA

[11] Columbia Univ, Dept Epidemiol, New York, NY USA

[12] Univ Vermont, Dept Pathol, Colchester, Essex, England

[13] Univ Vermont, Dept Biochem, Colchester, Essex, England

[14] Univ Calif Los Angeles, Sch Med, Div Cardiol, Los Angeles, CA 90024 USA

[15] Wake Forest Univ Hlth Sci, Div Publ Hlth Sci, Winston Salem, NC USA

来源：

ARCHIVES OF INTERNAL MEDICINE | 2008年 / 168卷 / 12期

关键词：

D O I：

10.1001/archinte.168.12.1333

中图分类号：

R5 [内科学];

学科分类号：

1002 [临床医学]; 100201 [内科学];

摘要：

Background: Coronary artery calcium (CAC) and carotid intima-media thickness (IMT) are noninvasive measures of atherosclerosis that consensus panels have recommended as possible additions to risk factor assessment for predicting the probability of cardiovascular disease (CVD) occurrence. Our objective was to assess whether maximum carotid IMT or CAC (Agatston score) is the better predictor of incident CVD. Methods: A prospective cohort study of subjects aged 45 to 84 years in 4 ethnic groups, who were initially free of CVD (n=6698) was performed, with standardized carotid IMT and CAC measures at baseline, in 6 field centers of the Multi-Ethnic Study of Atherosclerosis (MESA). The main outcome measure was the risk of incident CVD events (coronary heart disease, stroke, and fatal CVD) over a maximum of 5.3 years of follow-up. Results: There were 222 CVD events during follow-up. Coronary artery calcium was associated more strongly than carotid IMT with the risk of incident CVD. After adjustment for each other (CAC score and IMT) and traditional CVD risk factors, the hazard ratio of CVD increased 2.1-fold (95% confidence interval [CI], 1.8-2.5) for each 1-standard deviation (SD) increment of log-transformed CAC score, vs 1.3-fold (95% CI, 1.1-1.4) for each 1-SD increment of the maximum IMT. For coronary heart disease, the hazard ratios per 1-SD increment increased 2.5-fold (95% CI, 2.1-3.1) for CAC score and 1.2-fold (95% CI, 1.0-1.4) for IMT. A receiver operating characteristic curve analysis also suggested that CAC score was a better predictor of incident CVD than was IMT, with areas under the curve of 0.81 vs 0.78, respectively. Conclusion: Although whether and how to clinically use bioimaging tests of subclinical atherosclerosis remains a topic of debate, this study found that CAC score is a better predictor of subsequent CVD events than carotid IMT.

引用

页码：1333 / 1339

页数：7

共 23 条

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