title: A comparison of outcomes with coronary artery calcium scanning in unselected populations: the Multi-Ethnic Study of Atherosclerosis (MESA) and Heinz Nixdorf RECALL study (HNR).
abstract: BACKGROUND
  The Multi-Ethnic Study of Atherosclerosis (MESA) and the Heinz Nixdorf RECALL (Risk factors, Evaluation of Coronary Calcium and Lifestyle Factors) study (HNR) differed in regard to informing physicians and patients of the results of their subclinical atherosclerosis.
  
  
  OBJECTIVE
  This study investigates whether the association of the presence of coronary calcium with incident nonfatal and fatal cardiovascular events is different among these 2 large, population-based observational studies.
  
  
  METHODS
  All white subjects aged 45 to 75 years, free of baseline cardiovascular disease were included (n = 2232 in MESA; n = 3119 HNR participants). We studied the association between coronary calcium and event rates at 5 years, including hard cardiac events (myocardial infarction, cardiac death, resuscitated cardiac arrest), and separately added revascularizations and strokes (fatal and nonfatal) to determine adjusted hazard ratios.
  
  
  RESULTS
  Both cohorts showed low coronary heart disease (including revascularization) rates with zero coronary calcium (1.13% and 1.16% over 5 years in MESA and HNR, respectively) and increasing significantly in both groups with Agatston score 100 to 399 (6.71% and 4.52% in MESA and HNR, respectively) and Agatston score > 400 (12.5% and 13.54% in MESA and HNR, respectively) and showing strong independent predictive values for Agatston scores of 100 to 399 and >400, despite multivariable adjustment for risk factors. Risk factor-adjusted 5-year revascularization rates were nearly identical for HNR and MESA and were generally low for both studies (1.4% [45 of 3119] for HNR and 1.9% [43 of 2232] for MESA) over 5 years.
  
  
  CONCLUSIONS
  Across 2 culturally diverse populations, Agatston score >400 is a strong predictor of events. High Agatston score did not statistically result in revascularization, and knowledge of the presence of coronary calcium did not increase revascularizations.
authors.affiliation: Los Angeles Biomedical Research Center, 1124 W Carson St, Torrance, CA 90502, USA. mbudoff@labiomed.org
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Budoff
authors.forename: Stefan
authors.initials: S
authors.lastname: Möhlenkamp
authors.forename: Robyn
authors.initials: R
authors.lastname: McClelland
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Delaney
authors.forename: Marcus
authors.initials: M
authors.lastname: Bauer
authors.forename: Heinz Karl
authors.initials: HK
authors.lastname: Jöckel
authors.forename: Hagen
authors.initials: H
authors.lastname: Kälsch
authors.forename: Richard
authors.initials: R
authors.lastname: Kronmal
authors.forename: Khurram
authors.initials: K
authors.lastname: Nasir
authors.forename: Nils
authors.initials: N
authors.lastname: Lehmann
authors.forename: Susanne
authors.initials: S
authors.lastname: Moebus
authors.forename: Ken
authors.initials: K
authors.lastname: Mukamal
authors.forename: Raimund
authors.initials: R
authors.lastname: Erbel
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000208:ethnology* / Q000401:mortality; D005260:Female; D006801:Humans; D015994:Incidence; D008019:Life Style; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*; D044465:White People / Q000706:statistics & numerical data*
keywords: Coronary artery calcification; Heinz Nixdorf RECALL study; Multi-Ethnic Study of Atherosclerosis; Subclinical atherosclerosis