Cardiovascular imaging for assessing cardiovascular risk in asymptomatic men versus women: the multi-ethnic study of atherosclerosis (MESA).
BACKGROUND
Coronary artery calcium (CAC), carotid intima-media thickness, and left ventricular (LV) mass and geometry offer the potential to characterize incident cardiovascular disease (CVD) risk in clinically asymptomatic individuals. The objective of the study was to compare these cardiovascular imaging measures for their overall and sex-specific ability to predict CVD.


RESULTS
The study sample consisted of 4965 Multi-Ethnic Study of Atherosclerosis participants (48% men; mean age, 62±10 years). They were free of CVD at baseline and were followed for a median of 5.8 years. There were 297 CVD events, including 187 coronary heart disease (CHD) events, 65 strokes, and 91 heart failure (HF) events. CAC was most strongly associated with CHD (hazard ratio [HR], 2.3 per 1 SD; 95% CI, 1.9 to 2.8) and all CVD events (HR, 1.7; 95% CI, 1.5 to 1.9). Most strongly associated with stroke were LV mass (HR, 1.3; 95% CI, 1.1 to 1.7) and LV mass/volume ratio (HR, 1.3; 95% CI, 1.1 to 1.6). LV mass showed the strongest association with HF (HR, 1.8; 95% CI, 1.6 to 2.1). There were no significant interactions for imaging measures with sex and ethnicity for any CVD outcome. Compared with traditional risk factors alone, overall risk prediction (C statistic) for future CHD, HF, and all CVD was significantly improved by adding CAC, LV mass, and CAC, respectively (all P<0.05).


CONCLUSIONS
There was no evidence that imaging measures differed in association with incident CVD by sex. CAC was most strongly associated with CHD and CVD; LV mass and LV concentric remodeling best predicted stroke; and LV mass best predicted HF.
Department of Radiology, Johns Hopkins University, Baltimore, MD, USA.
Aditya
A
Jain
Robyn L
RL
McClelland
Joseph F
JF
Polak
Steven
S
Shea
Gregory L
GL
Burke
Diane E
DE
Bild
Karol E
KE
Watson
Matthew J
MJ
Budoff
Kiang
K
Liu
Wendy S
WS
Post
Aaron R
AR
Folsom
João A C
JA
Lima
David A
DA
Bluemke
D000368:Aged; D000369:Aged, 80 and over; D001161:Arteriosclerosis / Q000000981:diagnostic imaging / Q000208:ethnology; D002114:Calcinosis / Q000000981:diagnostic imaging* / Q000208:ethnology; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000208:ethnology*; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D015984:Causality; D015331:Cohort Studies; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000208:ethnology; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000473:pathology*; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D014057:Tomography, X-Ray Computed / Q000379:methods; D017539:Tunica Intima / Q000000981:diagnostic imaging; D017540:Tunica Media / Q000000981:diagnostic imaging; D014463:Ultrasonography