Subclinical Atherosclerosis and Relationship With Risk Factors of Coronary Artery Disease in a Rural Population.
BACKGROUND
Annually, over 150,000 cardiovascular events occur among individuals <65 years old in the United States, including asymptomatic ones. Coronary artery calcium (CAC), a subclinical marker of coronary artery disease (CAD), enhances risk stratification among asymptomatic individuals. This study assessed the prevalence of CAC in a rural population and determined relationships between traditional risk factors for CAD and CAC scores.


METHODS
During January 2011 to December 2012, asymptomatic individuals from central Appalachia were screened for CAC in the largest tertiary cardiovascular institute. Based on Agatston scale, participants were grouped into 4 CAC scores: zero (CAC = 0), mild (CAC = 1-99), moderate (CAC = 100-399) and severe (CAC ≥ 400). Multinomial logistic regression was used to examine associations between potential risk factors of CAD and CAC score.


RESULTS
Of 1,674 participants, 55.4% had positive CAC score (CAC > 0). Increasing age and being male were positively associated with higher CAC scores. Although there was significant association between mild CAC and hypertension and family history of CAD, moderate CAC was positively associated with smoking status. Except hypercholesterolemia and sedentary lifestyle, severe CAC was significantly associated with major health conditions (obesity, diabetes and hypertension), lifestyle (smoking) and family history of CAD.


CONCLUSIONS
More than half of participants in the CAC screening had subclinical CAD (CAC score > 0). The association between CAC score and CAD risk factors suggests that education about subclinical atherosclerosis among asymptomatic individuals in this region with high cardiovascular disease prevalence is needed because CAC improves CAD risk stratification, and the knowledge of CAC enhances medication adherence and motivates individuals towards beneficial behavioral/lifestyle modification.
Department of Health Services Management and Policy (HMM), College of Public Health, East Tennessee State University, Johnson City, Tennessee; Division of Cardiology (TP), James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee; Division of Epidemiology (SPV), Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas; Department of Biostatistics and Epidemiology (LW), College of Public Health, East Tennessee State University, Johnson City, Tennessee; Department of Internal Medicine (HBP), James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee; and Division of Cardiology, Los Angeles Biomedical Research Institute (MB), Torrance, California.
Hadii M
HM
Mamudu
Timir
T
Paul
Sreenivas P
SP
Veeranki
Liang
L
Wang
Hemang B
HB
Panchal
Matthew
M
Budoff
D000328:Adult; D000368:Aged; D001061:Appalachian Region; D050197:Atherosclerosis / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D002309:Cardiology / Q000379:methods / Q000592:standards; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D008019:Life Style; D008297:Male; D008403:Mass Screening; D055118:Medication Adherence; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012424:Rural Population; D012720:Severity of Illness Index; D012907:Smoking; D014057:Tomography, X-Ray Computed