Relationship of change in traditional cardiometabolic risk factors to change in coronary artery calcification among individuals with detectable subclinical atherosclerosis: the multi-ethnic study of atherosclerosis.
OBJECTIVE
Data describing relationships between change in risk factors and coronary artery calcification (CAC) are lacking and could inform optimal cardiovascular disease prevention and treatment strategies. This study aimed to examine how change in traditional cardiometabolic risk factors related to change in CAC among individuals with detectable subclinical atherosclerosis.


METHODS
Latent growth modeling was used to examine change in cardiometabolic risk factors (waist circumference, body mass index, systolic and diastolic blood pressure, high- and low-density lipoprotein cholesterol, triglycerides, and glucose) related to change in CAC up to an average 4.9-year follow-up in a multi-ethnic cohort of 3398 asymptomatic individuals (57.8% men) who had detectable CAC (score>0) at baseline, adjusting for baseline risk factor levels and CAC values, age, gender, race/ethnicity, smoking, family history of CVD, income, and use of antihypertensive, lipid-lowering, and glucose-lowering medications.


RESULTS
Greater declines in blood pressure (systolic and diastolic) and low-density lipoprotein cholesterol at follow-up were each associated with greater CAC progression. The observed inverse associations were attributable to greater CAC progression in participants taking antihypertensive and lipid-lowering drugs who, as expected, had declines in blood pressure and lipid levels, respectively. These inverse associations did not emerge in participants not taking these medications.


CONCLUSIONS
Among individuals with subclinical atherosclerosis, the unexpected inverse associations observed between change in blood pressure and lipid levels with CAC progression emphasize the importance of considering medication use, and, when feasible, the severity and duration of disease, in exploring associations between risk factors and CAC change.
Department of Psychology, University of Miami, United States. Electronic address: warguelles@psy.miami.edu.
William
W
Arguelles
Department of Psychology, University of Miami, United States.
Maria M
MM
Llabre
Department of Psychology, University of Miami, United States.
Frank J
FJ
Penedo
Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, United States; Department of Medicine, University of Illinois at Chicago, United States.
Martha L
ML
Daviglus
Department of Neurology, University of Miami Miller School of Medicine, United States.
Ralph L
RL
Sacco
Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, United States.
Kiang
K
Liu
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, United States.
Moyses
M
Szklo
Radiology, Tufts University School of Medicine, United States.
Joseph F
JF
Polak
Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, United States.
John
J
Eng
Division of Public Health Sciences, Wake Forest School of Medicine, United States.
Gregory L
GL
Burke
Department of Psychology, University of Miami, United States.
Neil
N
Schneiderman
D000368:Aged; D050197:Atherosclerosis / Q000150:complications* / Q000175:diagnosis / Q000378:metabolism / Q000503:physiopathology; D001786:Blood Glucose; D001794:Blood Pressure; D015992:Body Mass Index; D002784:Cholesterol / Q000097:blood; D003324:Coronary Artery Disease / Q000150:complications* / Q000378:metabolism / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D044469:Racial Groups; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood; D061205:Vascular Calcification / Q000150:complications* / Q000378:metabolism / Q000503:physiopathology; D055105:Waist Circumference
D001786:Blood Glucose; D014280:Triglycerides; D002784:Cholesterol
Atherosclerosis; Coronary artery calcification; Risk factors