title: Predictors of Long-Term Healthy Arterial Aging: Coronary Artery Calcium Nondevelopment in the MESA Study.
abstract: OBJECTIVE
  This study sought to determine the predictors of healthy arterial aging.
  
  
  BACKGROUND
  Long-term nondevelopment of coronary artery calcification (persistent CAC = 0) is a marker of healthy arterial aging. The predictors of this phenotype are not known.
  
  
  METHODS
  We analyzed 1,850 participants from MESA (Multi-Ethnic Study of Atherosclerosis) with baseline CAC = 0 who underwent a follow-up CAC scan at visit 5 (median 9.6 years after baseline). We examined the proportion with persistent CAC = 0 and calculated multivariable relative risks and area under the receiver operating characteristic curve for prediction of this healthy arterial aging phenotype.
  
  
  RESULTS
  We found that 55% of participants (n = 1,000) had persistent CAC = 0, and these individuals were significantly more likely to be younger, female, and have fewer traditional risk factors (RF). Participants with an ASCVD (Atherosclerotic Cardiovascular Disease Risk Score) risk score <2.5% were 53% more likely to have healthy arterial aging than were participants with an ASCVD score ≥7.5%. There was no significant association between the Healthy Lifestyle variables (body mass index, physical activity, Mediterranean diet, and never smoking) and persistent CAC = 0. The area under the receiver operating characteristic curve incorporating age, sex, and ethnicity was 0.65, indicating fair to poor discrimination. No single traditional RF or combination of other risk factors increased the area under the receiver operating characteristic curve by more than 0.05.
  
  
  CONCLUSIONS
  Whereas participants free of traditional cardiovascular disease RF were significantly more likely to have persistent CAC = 0, there was no single RF or specific low-risk RF phenotype that markedly improved the discrimination of persistent CAC = 0 over demographic variables. Therefore, we conclude that healthy arterial aging may be predominantly influenced by the long-term maintenance of a low cardiovascular disease risk profile or yet to be determined genetic factors rather than the absence of any specific RF cluster identified in late adulthood.
authors.affiliation: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland. Electronic address: seamus.whelton@jhmi.edu.
authors.forename: Seamus P
authors.initials: SP
authors.lastname: Whelton
authors.affiliation: Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Silverman
authors.affiliation: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland.
authors.forename: John W
authors.initials: JW
authors.lastname: McEvoy
authors.affiliation: Los Angeles Biomedical Research Institute at Harbor, University of California-Los Angeles, Los Angeles, California.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Budoff
authors.affiliation: Cardiovascular Division and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Ron
authors.initials: R
authors.lastname: Blankstein
authors.affiliation: Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: John
authors.initials: J
authors.lastname: Eng
authors.affiliation: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland.
authors.forename: Roger S
authors.initials: RS
authors.lastname: Blumenthal
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Moyses
authors.initials: M
authors.lastname: Szklo
authors.affiliation: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland; Center for Healthcare Advancement & Outcomes, Baptist Health South Florida, Miami, Florida; Department of Medicine Herbert Wertheim College of Medicine & Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, Florida; Miami Cardiac & Vascular Institute (MCVI), Baptist Health South Florida, Miami, Florida.
authors.forename: Khurram
authors.initials: K
authors.lastname: Nasir
authors.affiliation: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Blaha
mesh_terms: D000367:Age Factors; D000368:Aged; D000375:Aging / Q000502:physiology*; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000032:analysis*; D015331:Cohort Studies; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000208:ethnology* / Q000473:pathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology; D038441:Diet, Mediterranean; D015444:Exercise / Q000502:physiology; D005260:Female; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D040242:Risk Reduction Behavior; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology; D014057:Tomography, X-Ray Computed / Q000379:methods; D061205:Vascular Calcification / Q000000981:diagnostic imaging* / Q000208:ethnology / Q000503:physiopathology
chemical_list: D002097:C-Reactive Protein
keywords: arterial aging; cardiac computed tomography; cardiovascular disease; coronary artery calcium