title: Progression of coronary calcium and incident coronary heart disease events: MESA (Multi-Ethnic Study of Atherosclerosis).
abstract: OBJECTIVE
  The study examined whether progression of coronary artery calcium (CAC) is a predictor of future coronary heart disease (CHD) events.
  
  
  BACKGROUND
  CAC predicts CHD events and serial measurement of CAC has been proposed to evaluate atherosclerosis progression.
  
  
  METHODS
  We studied 6,778 persons (52.8% female) aged 45 to 84 years from the MESA (Multi-Ethnic Study of Atherosclerosis) study. A total of 5,682 persons had baseline and follow-up CAC scans approximately 2.5 ± 0.8 years apart; multiple imputation was used to account for the remainder (n = 1,096) missing follow-up scans. Median follow-up duration from the baseline was 7.6 (max = 9.0) years. CAC change was assessed by absolute change between baseline and follow-up CAC. Cox proportional hazards regression providing hazard ratios (HRs) examined the relation of change in CAC with CHD events, adjusting for age, gender, ethnicity, baseline calcium score, and other risk factors.
  
  
  RESULTS
  A total of 343 and 206 hard CHD events occurred. The annual change in CAC averaged 24.9 ± 65.3 Agatston units. Among persons without CAC at baseline (n = 3,396), a 5-unit annual change in CAC was associated with an adjusted HR (95% Confidence Interval) of 1.4 (1.0 to 1.9) for total and 1.5 (1.1 to 2.1) for hard CHD. Among those with CAC >0 at baseline, HRs (per 100 unit annual change) were 1.2 (1.1 to 1.4) and 1.3 (1.1 to 1.5), respectively. Among participants with baseline CAC, those with annual progression of ≥300 units had adjusted HRs of 3.8 (1.5 to 9.6) for total and 6.3 (1.9 to 21.5) for hard CHD compared to those without progression.
  
  
  CONCLUSIONS
  Progression of CAC is associated with an increased risk for future hard and total CHD events.
authors.affiliation: Division of Cardiology, LA Biomedical Research Institute, Harbor-UCLA Medical Center, Los Angeles, California, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Budoff
authors.forename: Rebekah
authors.initials: R
authors.lastname: Young
authors.forename: Victor A
authors.initials: VA
authors.lastname: Lopez
authors.forename: Richard A
authors.initials: RA
authors.lastname: Kronmal
authors.forename: Khurram
authors.initials: K
authors.lastname: Nasir
authors.forename: Roger S
authors.initials: RS
authors.lastname: Blumenthal
authors.forename: Robert C
authors.initials: RC
authors.lastname: Detrano
authors.forename: Diane E
authors.initials: DE
authors.lastname: Bild
authors.forename: Alan D
authors.initials: AD
authors.lastname: Guerci
authors.forename: Kiang
authors.initials: K
authors.lastname: Liu
authors.forename: Steven
authors.initials: S
authors.lastname: Shea
authors.forename: Moyses
authors.initials: M
authors.lastname: Szklo
authors.forename: Wendy
authors.initials: W
authors.lastname: Post
authors.forename: Joao
authors.initials: J
authors.lastname: Lima
authors.forename: Alain
authors.initials: A
authors.lastname: Bertoni
authors.forename: Nathan D
authors.initials: ND
authors.lastname: Wong
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D001213:Asian / Q000706:statistics & numerical data; D002114:Calcinosis / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000208:ethnology*; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000208:ethnology*; D003431:Cross-Cultural Comparison; D018450:Disease Progression; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014481:United States; D044465:White People / Q000706:statistics & numerical data