title: Distribution and burden of newly detected coronary artery calcium: Results from the Multi-Ethnic Study of Atherosclerosis.
abstract: BACKGROUND
  The transition from no coronary artery calcium (CAC) to detectable CAC is important, as even mild CAC is associated with increased cardiovascular events. We sought to characterize the anatomic distribution and burden of newly detectable CAC over 10-year follow-up.
  
  
  METHODS
  We evaluated 3112 participants (mean age, 58 years; 64% female) with baseline CAC = 0 from the Multi-Ethnic Study of Atherosclerosis. Participants underwent repeat CAC testing at different time intervals (between 2-10 years after baseline) per the Multi-Ethnic Study of Atherosclerosis protocol. Among participants who developed CAC on a follow-up scan, we used logistic regression and marginal probability modeling to describe the coronary distribution and burden of new CAC by age, sex, and race after adjustment for cardiovascular risk factors and time to detection.
  
  
  RESULTS
  A total of 1125 participants developed detectable CAC during follow-up with a mean time to detection of 6.1 ± 3 years. New CAC was most commonly isolated to 1 vessel (72% of participants), with the left anterior descending artery (44% of total) most commonly affected followed by the right coronary (12%), left circumflex (10%), and left main (6%). These patterns were similar across age, sex, and race. In multivariate models, residual predictors of multivessel CAC (28% of total) included male sex, African American or Hispanic race, hypertension, obesity, and diabetes. At the first detection of CAC >0, burden was usually low with median Agatston CAC score of 7.1 and <5% with CAC scores >100.
  
  
  CONCLUSIONS
  New-onset CAC most commonly involves just 1 vessel, occurs in the left anterior descending artery, and has low CAC burden. New CAC can be detected at an early stage when aggressive preventive strategies may provide benefit.
authors.affiliation: Department of Internal Medicine, UPMC McKeesport Hospital, McKeesport, PA, USA; The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Hospital, Carnegie 565A, 600 N. Wolfe Street, Baltimore, MD 21287, USA.
authors.forename: Krishna
authors.initials: K
authors.lastname: Alluri
authors.affiliation: The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Hospital, Carnegie 565A, 600 N. Wolfe Street, Baltimore, MD 21287, USA.
authors.forename: John W
authors.initials: JW
authors.lastname: McEvoy
authors.affiliation: The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Hospital, Carnegie 565A, 600 N. Wolfe Street, Baltimore, MD 21287, USA.
authors.forename: Zeina A
authors.initials: ZA
authors.lastname: Dardari
authors.affiliation: The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Hospital, Carnegie 565A, 600 N. Wolfe Street, Baltimore, MD 21287, USA.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Jones
authors.affiliation: The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Hospital, Carnegie 565A, 600 N. Wolfe Street, Baltimore, MD 21287, USA; Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, FL, USA.
authors.forename: Khurram
authors.initials: K
authors.lastname: Nasir
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Ron
authors.initials: R
authors.lastname: Blankstein
authors.affiliation: The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Hospital, Carnegie 565A, 600 N. Wolfe Street, Baltimore, MD 21287, USA; South Beach Preventive Cardiology Center, University of Miami, Miami, FL, USA.
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Rivera
authors.affiliation: South Beach Preventive Cardiology Center, University of Miami, Miami, FL, USA.
authors.forename: Arthur A
authors.initials: AA
authors.lastname: Agatston
authors.affiliation: Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA.
authors.forename: Joel D
authors.initials: JD
authors.lastname: Kaufman
authors.affiliation: Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Budoff
authors.affiliation: The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Hospital, Carnegie 565A, 600 N. Wolfe Street, Baltimore, MD 21287, USA.
authors.forename: Roger S
authors.initials: RS
authors.lastname: Blumenthal
authors.affiliation: The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Hospital, Carnegie 565A, 600 N. Wolfe Street, Baltimore, MD 21287, USA. Electronic address: mblaha1@jhmi.edu.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Blaha
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015984:Causality; D015897:Comorbidity; D017023:Coronary Angiography / Q000706:statistics & numerical data*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000517:prevention & control; D017281:Cost of Illness; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D014481:United States / Q000208:ethnology; D061205:Vascular Calcification / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000517:prevention & control
keywords: Coronary artery calcium; Left anterior descending artery; Left circumflex artery; Left main artery; Right coronary artery