title: Progression of coronary artery calcification seems to be inevitable, but predictable - results of the Heinz Nixdorf Recall (HNR) study.
abstract: OBJECTIVE
  Coronary artery calcification (CAC), as a sign of atherosclerosis, can be detected and progression quantified using computed tomography (CT). We develop a tool for predicting CAC progression.
  
  
  RESULTS
  In 3481 participants (45-74 years, 53.1% women) CAC percentiles at baseline (CACb) and after five years (CAC₅y) were evaluated, demonstrating progression along gender-specific percentiles, which showed exponentially shaped age-dependence. Using quantile regression on the log-scale (log(CACb+1)) we developed a tool to individually predict CAC₅y, and compared to observed CAC₅y. The difference between observed and predicted CAC₅y (log-scale, mean±SD) was 0.08±1.11 and 0.06±1.29 in men and women. Agreement reached a kappa-value of 0.746 (95% confidence interval: 0.732-0.760) and concordance correlation (log-scale) of 0.886 (0.879-0.893). Explained variance of observed by predicted log(CAC₅y+1) was 80.1% and 72.0% in men and women, and 81.0 and 73.6% including baseline risk factors. Evaluating the tool in 1940 individuals with CACb>0 and CACb<400 at baseline, of whom 242 (12.5%) developed CAC₅y>400, yielded a sensitivity of 59.5%, specificity 96.1%, (+) and (-) predictive values of 68.3% and 94.3%. A pre-defined acceptance range around predicted CAC₅y contained 68.1% of observed CAC₅y; only 20% were expected by chance. Age, blood pressure, lipid-lowering medication, diabetes, and smoking contributed to progression above the acceptance range in men and, excepting age, in women.
  
  
  CONCLUSIONS
  CAC nearly inevitably progresses with limited influence of cardiovascular risk factors. This allowed the development of a mathematical tool for prediction of individual CAC progression, enabling anticipation of the age when CAC thresholds of high risk are reached.
authors: University Clinic of Cardiology, West-German Heart Center Essen and erbel@uk-essen.de.
authors: Raimund
authors: R
authors: Erbel
authors: Institute for Medical Informatics, Biometry and Epidemiology, University Duisburg-Essen, Hufelandstrasse 55, Essen D-45122, Germany.
authors: Nils
authors: N
authors: Lehmann
authors: University Clinic of Cardiology, West-German Heart Center Essen and.
authors: Sofia
authors: S
authors: Churzidse
authors: University Clinic of Cardiology, West-German Heart Center Essen and.
authors: Michael
authors: M
authors: Rauwolf
authors: University Clinic of Cardiology, West-German Heart Center Essen and.
authors: Amir A
authors: AA
authors: Mahabadi
authors: University Clinic of Cardiology, West-German Heart Center Essen and Medical Clinic II, Bethanien Hospital, Moers, Germany.
authors: Stefan
authors: S
authors: Möhlenkamp
authors: Institute for Medical Informatics, Biometry and Epidemiology, University Duisburg-Essen, Hufelandstrasse 55, Essen D-45122, Germany.
authors: Susanne
authors: S
authors: Moebus
authors: University Clinic of Cardiology, West-German Heart Center Essen and.
authors: Marcus
authors: M
authors: Bauer
authors: University Clinic of Cardiology, West-German Heart Center Essen and.
authors: Hagen
authors: H
authors: Kälsch
authors: Alfred-Krupp Hospital, Essen, Germany.
authors: Thomas
authors: T
authors: Budde
authors: Alfred-Krupp Hospital, Essen, Germany.
authors: Michael
authors: M
authors: Montag
authors: Cardioangiological Center Bethanien, Frankfurt am Main, Germany.
authors: Axel
authors: A
authors: Schmermund
authors: Institute of Clinical Epidemiology, Medical Faculty University Halle-Wittenberg, Wittenberg, Germany Department of Epidemiology, School of Public Health, Boston University, Boston, MA, USA.
authors: Andreas
authors: A
authors: Stang
authors: Institute of Clinical Chemistry and Laboratory Medicine, University Duisburg-Essen, Essen, Germany.
authors: Dagmar
authors: D
authors: Führer-Sakel
authors: University Clinic of Neurology, University Duisburg-Essen, Essen, Germany.
authors: Christian
authors: C
authors: Weimar
authors: Institute for Medical Informatics, Biometry and Epidemiology, University Duisburg-Essen, Hufelandstrasse 55, Essen D-45122, Germany.
authors: Ulla
authors: U
authors: Roggenbuck
authors: Institute of Medical Sociology Medical Faculty University of Düsseldorf, Düsseldorf, Germany.
authors: Nico
authors: N
authors: Dragano
authors: Institute for Medical Informatics, Biometry and Epidemiology, University Duisburg-Essen, Hufelandstrasse 55, Essen D-45122, Germany.
authors: Karl-Heinz
authors: KH
authors: Jöckel
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000401:mortality; D018450:Disease Progression; D042241:Early Diagnosis; D004812:Epidemiologic Methods; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D061205:Vascular Calcification / Q000175:diagnosis* / Q000401:mortality
keywords: CT; Coronary artery calcification; Epidemiology; Heinz Nixdorf Recall study; Imaging; Progression of atherosclerosis