Nontraditional Risk Markers for Incident Coronary Artery Calcium Among Persons ≥65 Years of Age

Alexander C Razavi; Omar Dzaye; Erin D Michos; Matthew J Budoff; Norrina B Allen; Joao A C Lima; Joseph F Polak; Wendy S Post; Khurram Nasir; Roger S Blumenthal; Laurence S Sperling; Michael J Blaha; Seamus P Whelton

doi:10.1016/j.jacadv.2023.100755

Nontraditional Risk Markers for Incident Coronary Artery Calcium Among Persons ≥65 Years of Age

JACC Adv. 2023 Dec 19;3(2):100755. doi: 10.1016/j.jacadv.2023.100755. eCollection 2024 Feb.

Authors

Alexander C Razavi^{1

2}, Omar Dzaye², Erin D Michos^{2

3}, Matthew J Budoff⁴, Norrina B Allen⁵, Joao A C Lima³, Joseph F Polak⁶, Wendy S Post^{2

3}, Khurram Nasir⁷, Roger S Blumenthal^{2

3}, Laurence S Sperling¹, Michael J Blaha^{2

3}, Seamus P Whelton^{2

3}

Affiliations

¹ Center for Heart Disease Prevention, Emory University School of Medicine, Atlanta, Georgia, USA.
² Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
³ Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
⁴ Lundquist Institute, Harbor-UCLA Medical Center, Torrance, California, USA.
⁵ Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
⁶ Department of Radiology, Tufts Medical Center, Boston, Massachusetts, USA.
⁷ Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA.

Abstract

Background: The initiation of coronary artery calcium (CAC) is an important physiologic milestone associated with increased cardiovascular disease risk. However, traditional risk factors (RF) do not perform well for predicting incident CAC among the 54 million older U.S. adults.

Objectives: The authors sought to assess the association between nontraditional cardiovascular disease RF and incident CAC in older persons.

Methods: There were 815 MESA (Multi-Ethnic Study of Atherosclerosis) participants ≥65 years of age who had CAC = 0 at Visit 1 and a follow-up CAC scan. Multivariable adjusted Cox hazards ratios (aHR) and C-statistics were calculated to examine the association of nontraditional RF with incident CAC.

Results: The mean age was 70.2 years and 67% were women. The median follow-up time to repeat CAC scan was 3.6 years (IQR: 2.6-9.2 years) and 45% of participants developed incident CAC. Albuminuria (aHR: 1.50, 95% CI: 1.07-2.09), carotid plaque (aHR: 1.32, 95% CI: 1.04-1.66), and thoracic aortic calcification (TAC) (aHR: 1.38, 95% CI: 1.10-1.75) were significantly associated with incident CAC, while higher levels of nontraditional RF including apolipoprotein-B, lipoprotein(a), high-sensitivity troponin T, and N-terminal pro-brain natriuretic peptide were not. When added to demographics, albuminuria, carotid plaque, and TAC provided a greater C-statistic improvement (+0.047, P = 0.004) vs all traditional RF combined (+0.033, P = 0.05).

Conclusions: Among nontraditional RF and measures of subclinical atherosclerosis, only albuminuria, carotid plaque, and TAC were significantly associated with incident CAC in persons ≥65 years of age. Identification of albuminuria or extracoronary atherosclerosis may help guide the timing of repeat CAC scoring in older persons with baseline CAC = 0.

Keywords: age; aged; atherosclerosis; coronary artery calcium; risk factors.