title: Comparison of coronary artery calcium presence, carotid plaque presence, and carotid intima-media thickness for cardiovascular disease prediction in the Multi-Ethnic Study of Atherosclerosis.
abstract: BACKGROUND
  Presence of coronary artery calcium (CAC), carotid plaque, and increased carotid intima-media thickness (IMT) may indicate elevated cardiovascular disease (CVD) risk; however, no large studies have compared them directly. This study compares predictive uses of CAC presence, carotid artery plaque presence, and high IMT for incident CVD events.
  
  
  RESULTS
  Participants were from the Multi-Ethnic Study of Atherosclerosis (MESA). Predictive values of carotid plaque, IMT, and CAC presence were compared using Cox proportional hazards models, c-statistics, and net reclassification indices. The 6779 participants were mean (SD) 62.2 (10.2) years old; 49.9% had CAC, and 46.7% had carotid plaque. The mean left and right IMT were 0.754 (0.210) mm and 0.751 (0.187) mm, respectively. After 9.5 years (mean), 538 CVD events, 388 coronary heart disease (CHD) events, and 196 stroke/transient ischemic attacks were observed. CAC presence was a stronger predictor of incident CVD and CHD than carotid ultrasound measures. Mean IMT≥75th percentile (for age, sex, and race) alone did not predict events. Compared with traditional risk factors, c-statistics for CVD (c=0.756) and CHD (c=0.752) increased the most by the addition of CAC presence (CVD, 0.776; CHD, 0.784; P<0.001) followed by carotid plaque presence (CVD, c=0.760; CHD, c=0.757; P<0.05). Compared with risk factors (c=0.782), carotid plaque presence (c=0.787; P=0.045) but not CAC (c=0.785; P=0.438) improved prediction of stroke/transient ischemic attacks.
  
  
  CONCLUSIONS
  In adults without CVD, CAC presence improves prediction of CVD and CHD more than carotid plaque presence or high IMT. CAC and carotid ultrasound parameters performed similarly for stroke/transient ischemic attack event prediction.
authors.affiliation: From the Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI (A.D.G., M.C.T., J.H.S.); Departments of Biostatistics (R.Y., R.K.), Environmental & Occupational Health Sciences (J.K.), Epidemiology (J.A.D., J.K.), and Statistics (R.K.), University of Washington, Seattle, WA; Departments of Epidemiology and Medicine, Johns Hopkins University, Baltimore, MD (M.J.B., W.S.P., R.F.G.); Department of Medicine, University of California, Los Angeles (M.J.B.); Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC (G.L.B.); Department of Epidemiology, University of Minnesota School of Public Health, Minneapolis (A.R.F.); and Departments of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.L.).
authors.forename: Adam D
authors.initials: AD
authors.lastname: Gepner
authors.affiliation: From the Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI (A.D.G., M.C.T., J.H.S.); Departments of Biostatistics (R.Y., R.K.), Environmental & Occupational Health Sciences (J.K.), Epidemiology (J.A.D., J.K.), and Statistics (R.K.), University of Washington, Seattle, WA; Departments of Epidemiology and Medicine, Johns Hopkins University, Baltimore, MD (M.J.B., W.S.P., R.F.G.); Department of Medicine, University of California, Los Angeles (M.J.B.); Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC (G.L.B.); Department of Epidemiology, University of Minnesota School of Public Health, Minneapolis (A.R.F.); and Departments of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.L.).
authors.forename: Rebekah
authors.initials: R
authors.lastname: Young
authors.affiliation: From the Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI (A.D.G., M.C.T., J.H.S.); Departments of Biostatistics (R.Y., R.K.), Environmental & Occupational Health Sciences (J.K.), Epidemiology (J.A.D., J.K.), and Statistics (R.K.), University of Washington, Seattle, WA; Departments of Epidemiology and Medicine, Johns Hopkins University, Baltimore, MD (M.J.B., W.S.P., R.F.G.); Department of Medicine, University of California, Los Angeles (M.J.B.); Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC (G.L.B.); Department of Epidemiology, University of Minnesota School of Public Health, Minneapolis (A.R.F.); and Departments of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.L.).
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Delaney
authors.affiliation: From the Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI (A.D.G., M.C.T., J.H.S.); Departments of Biostatistics (R.Y., R.K.), Environmental & Occupational Health Sciences (J.K.), Epidemiology (J.A.D., J.K.), and Statistics (R.K.), University of Washington, Seattle, WA; Departments of Epidemiology and Medicine, Johns Hopkins University, Baltimore, MD (M.J.B., W.S.P., R.F.G.); Department of Medicine, University of California, Los Angeles (M.J.B.); Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC (G.L.B.); Department of Epidemiology, University of Minnesota School of Public Health, Minneapolis (A.R.F.); and Departments of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.L.).
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Tattersall
authors.affiliation: From the Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI (A.D.G., M.C.T., J.H.S.); Departments of Biostatistics (R.Y., R.K.), Environmental & Occupational Health Sciences (J.K.), Epidemiology (J.A.D., J.K.), and Statistics (R.K.), University of Washington, Seattle, WA; Departments of Epidemiology and Medicine, Johns Hopkins University, Baltimore, MD (M.J.B., W.S.P., R.F.G.); Department of Medicine, University of California, Los Angeles (M.J.B.); Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC (G.L.B.); Department of Epidemiology, University of Minnesota School of Public Health, Minneapolis (A.R.F.); and Departments of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.L.).
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Blaha
authors.affiliation: From the Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI (A.D.G., M.C.T., J.H.S.); Departments of Biostatistics (R.Y., R.K.), Environmental & Occupational Health Sciences (J.K.), Epidemiology (J.A.D., J.K.), and Statistics (R.K.), University of Washington, Seattle, WA; Departments of Epidemiology and Medicine, Johns Hopkins University, Baltimore, MD (M.J.B., W.S.P., R.F.G.); Department of Medicine, University of California, Los Angeles (M.J.B.); Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC (G.L.B.); Department of Epidemiology, University of Minnesota School of Public Health, Minneapolis (A.R.F.); and Departments of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.L.).
authors.forename: Wendy S
authors.initials: WS
authors.lastname: Post
authors.affiliation: From the Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI (A.D.G., M.C.T., J.H.S.); Departments of Biostatistics (R.Y., R.K.), Environmental & Occupational Health Sciences (J.K.), Epidemiology (J.A.D., J.K.), and Statistics (R.K.), University of Washington, Seattle, WA; Departments of Epidemiology and Medicine, Johns Hopkins University, Baltimore, MD (M.J.B., W.S.P., R.F.G.); Department of Medicine, University of California, Los Angeles (M.J.B.); Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC (G.L.B.); Department of Epidemiology, University of Minnesota School of Public Health, Minneapolis (A.R.F.); and Departments of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.L.).
authors.forename: Rebecca F
authors.initials: RF
authors.lastname: Gottesman
authors.affiliation: From the Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI (A.D.G., M.C.T., J.H.S.); Departments of Biostatistics (R.Y., R.K.), Environmental & Occupational Health Sciences (J.K.), Epidemiology (J.A.D., J.K.), and Statistics (R.K.), University of Washington, Seattle, WA; Departments of Epidemiology and Medicine, Johns Hopkins University, Baltimore, MD (M.J.B., W.S.P., R.F.G.); Department of Medicine, University of California, Los Angeles (M.J.B.); Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC (G.L.B.); Department of Epidemiology, University of Minnesota School of Public Health, Minneapolis (A.R.F.); and Departments of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.L.).
authors.forename: Richard
authors.initials: R
authors.lastname: Kronmal
authors.affiliation: From the Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI (A.D.G., M.C.T., J.H.S.); Departments of Biostatistics (R.Y., R.K.), Environmental & Occupational Health Sciences (J.K.), Epidemiology (J.A.D., J.K.), and Statistics (R.K.), University of Washington, Seattle, WA; Departments of Epidemiology and Medicine, Johns Hopkins University, Baltimore, MD (M.J.B., W.S.P., R.F.G.); Department of Medicine, University of California, Los Angeles (M.J.B.); Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC (G.L.B.); Department of Epidemiology, University of Minnesota School of Public Health, Minneapolis (A.R.F.); and Departments of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.L.).
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Budoff
authors.affiliation: From the Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI (A.D.G., M.C.T., J.H.S.); Departments of Biostatistics (R.Y., R.K.), Environmental & Occupational Health Sciences (J.K.), Epidemiology (J.A.D., J.K.), and Statistics (R.K.), University of Washington, Seattle, WA; Departments of Epidemiology and Medicine, Johns Hopkins University, Baltimore, MD (M.J.B., W.S.P., R.F.G.); Department of Medicine, University of California, Los Angeles (M.J.B.); Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC (G.L.B.); Department of Epidemiology, University of Minnesota School of Public Health, Minneapolis (A.R.F.); and Departments of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.L.).
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Burke
authors.affiliation: From the Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI (A.D.G., M.C.T., J.H.S.); Departments of Biostatistics (R.Y., R.K.), Environmental & Occupational Health Sciences (J.K.), Epidemiology (J.A.D., J.K.), and Statistics (R.K.), University of Washington, Seattle, WA; Departments of Epidemiology and Medicine, Johns Hopkins University, Baltimore, MD (M.J.B., W.S.P., R.F.G.); Department of Medicine, University of California, Los Angeles (M.J.B.); Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC (G.L.B.); Department of Epidemiology, University of Minnesota School of Public Health, Minneapolis (A.R.F.); and Departments of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.L.).
authors.forename: Aaron R
authors.initials: AR
authors.lastname: Folsom
authors.affiliation: From the Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI (A.D.G., M.C.T., J.H.S.); Departments of Biostatistics (R.Y., R.K.), Environmental & Occupational Health Sciences (J.K.), Epidemiology (J.A.D., J.K.), and Statistics (R.K.), University of Washington, Seattle, WA; Departments of Epidemiology and Medicine, Johns Hopkins University, Baltimore, MD (M.J.B., W.S.P., R.F.G.); Department of Medicine, University of California, Los Angeles (M.J.B.); Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC (G.L.B.); Department of Epidemiology, University of Minnesota School of Public Health, Minneapolis (A.R.F.); and Departments of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.L.).
authors.forename: Kiang
authors.initials: K
authors.lastname: Liu
authors.affiliation: From the Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI (A.D.G., M.C.T., J.H.S.); Departments of Biostatistics (R.Y., R.K.), Environmental & Occupational Health Sciences (J.K.), Epidemiology (J.A.D., J.K.), and Statistics (R.K.), University of Washington, Seattle, WA; Departments of Epidemiology and Medicine, Johns Hopkins University, Baltimore, MD (M.J.B., W.S.P., R.F.G.); Department of Medicine, University of California, Los Angeles (M.J.B.); Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC (G.L.B.); Department of Epidemiology, University of Minnesota School of Public Health, Minneapolis (A.R.F.); and Departments of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.L.).
authors.forename: Joel
authors.initials: J
authors.lastname: Kaufman
authors.affiliation: From the Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI (A.D.G., M.C.T., J.H.S.); Departments of Biostatistics (R.Y., R.K.), Environmental & Occupational Health Sciences (J.K.), Epidemiology (J.A.D., J.K.), and Statistics (R.K.), University of Washington, Seattle, WA; Departments of Epidemiology and Medicine, Johns Hopkins University, Baltimore, MD (M.J.B., W.S.P., R.F.G.); Department of Medicine, University of California, Los Angeles (M.J.B.); Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC (G.L.B.); Department of Epidemiology, University of Minnesota School of Public Health, Minneapolis (A.R.F.); and Departments of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.L.). jhs@medicine.wisc.edu.
authors.forename: James H
authors.initials: JH
authors.lastname: Stein
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002340:Carotid Artery Diseases / Q000175:diagnosis* / Q000208:ethnology; D059168:Carotid Intima-Media Thickness; D016009:Chi-Square Distribution; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000208:ethnology; D018450:Disease Progression; D005006:Ethnicity; D005260:Female; D006801:Humans; D015994:Incidence; D002546:Ischemic Attack, Transient / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014481:United States; D061205:Vascular Calcification / Q000175:diagnosis* / Q000208:ethnology
keywords: atherosclerosis; cardiovascular disease; carotid arteries; neuroimaging; risk factors