title: Risk Factors for Long-Term Coronary Artery Calcium Progression in the Multi-Ethnic Study of Atherosclerosis.
abstract: BACKGROUND
  Coronary artery calcium (CAC) detected by noncontrast cardiac computed tomography scanning is a measure of coronary atherosclerosis burden. Increasing CAC levels have been strongly associated with increased coronary events. Prior studies of cardiovascular disease risk factors and CAC progression have been limited by short follow-up or restricted to patients with advanced disease.
  
  
  RESULTS
  We examined cardiovascular disease risk factors and CAC progression in a prospective multiethnic cohort study. CAC was measured 1 to 4 times (mean 2.5 scans) over 10 years in 6810 adults without preexisting cardiovascular disease. Mean CAC progression was 23.9 Agatston units/year. An innovative application of mixed-effects models investigated associations between cardiovascular disease risk factors and CAC progression. This approach adjusted for time-varying factors, was flexible with respect to follow-up time and number of observations per participant, and allowed simultaneous control of factors associated with both baseline CAC and CAC progression. Models included age, sex, study site, scanner type, and race/ethnicity. Associations were observed between CAC progression and age (14.2 Agatston units/year per 10 years [95% CI 13.0 to 15.5]), male sex (17.8 Agatston units/year [95% CI 15.3 to 20.3]), hypertension (13.8 Agatston units/year [95% CI 11.2 to 16.5]), diabetes (31.3 Agatston units/year [95% CI 27.4 to 35.3]), and other factors.
  
  
  CONCLUSIONS
  CAC progression analyzed over 10 years of follow-up, with a novel analytical approach, demonstrated strong relationships with risk factors for incident cardiovascular events. Longitudinal CAC progression analyzed in this framework can be used to evaluate novel cardiovascular risk factors.
authors.affiliation: University of Washington School of Public Health, Seattle, WA (A.J.G., L.S., R.L.M.C., C.O., R.K., J.D.K.).
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Gassett
authors.affiliation: University of Washington School of Public Health, Seattle, WA (A.J.G., L.S., R.L.M.C., C.O., R.K., J.D.K.).
authors.forename: Lianne
authors.initials: L
authors.lastname: Sheppard
authors.affiliation: University of Washington School of Public Health, Seattle, WA (A.J.G., L.S., R.L.M.C., C.O., R.K., J.D.K.).
authors.forename: Robyn L
authors.initials: RL
authors.lastname: McClelland
authors.affiliation: University of Washington School of Public Health, Seattle, WA (A.J.G., L.S., R.L.M.C., C.O., R.K., J.D.K.).
authors.forename: Casey
authors.initials: C
authors.lastname: Olives
authors.affiliation: University of Washington School of Public Health, Seattle, WA (A.J.G., L.S., R.L.M.C., C.O., R.K., J.D.K.).
authors.forename: Richard
authors.initials: R
authors.lastname: Kronmal
authors.affiliation: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.J.B.).
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Blaha
authors.affiliation: Los Angeles Biomedical Research Institute at Harbor - UCLA Medical Center, Torrance, CA (M.B.).
authors.forename: Matthew
authors.initials: M
authors.lastname: Budoff
authors.affiliation: University of Washington School of Public Health, Seattle, WA (A.J.G., L.S., R.L.M.C., C.O., R.K., J.D.K.).
authors.forename: Joel D
authors.initials: JD
authors.lastname: Kaufman
mesh_terms: D000367:Age Factors; D000368:Aged; D015897:Comorbidity; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000208:ethnology*; D018450:Disease Progression; D005006:Ethnicity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014481:United States / Q000453:epidemiology; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000208:ethnology*
keywords: atherosclerosis; calcium; risk factors