title: Association between a healthy cardiovascular risk factor profile and coronary artery calcium score: Results from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).
abstract: BACKGROUND
  Our goal was to evaluate cross-sectionally the association between ideal risk factor (IRF) profile and the presence and severity of subclinical atherosclerosis measured as coronary artery calcium (CAC) in the Brazilian Longitudinal Study of Adult Health.
  
  
  METHODS
  We included 4,077 participants with no prior history of cardiovascular disease aged 35 to 74 years who underwent CAC measurement. The 2010 Task Force of the American Heart Association cutoffs were used to define the ideal level of smoking, physical activity, diet, blood pressure, glucose/cholesterol levels, and body mass index.
  
  
  RESULTS
  Participants were categorized according the number of IRF: 0 to 1 (n = 1,025, 25.1%), 2 (n = 1,200, 29.4%), 3 to 4 (n = 1,551, 38.1%), or 5 to 7 (n = 301, 7.4%). Compared to individuals with 0 to 1 IRF, the odds ratio of participants with 2 IRFs presenting with CAC >0 (compared to 0), ≥100 (compared to <100), and ≥400 (compared to <400) was 0.75 (95% CI 0.62-0.91), 0.64 (0.49-0.84), and 0.75 (0.49-1.15), respectively. Similarly, the odds ratios of CACs >0, ≥100, and ≥400 in individuals with 3 to 4 IRFs were 0.59 (95% CI 0.48-0.71), 0.46 (0.34-0.62), and 0.50 (0.30-0.83), respectively, and, for individuals with 5 to 7 IRFs, were 0.36 (95% CI 0.24-0.56), 0.22 (0.09-0.55), and 0.20 (0.03-1.45), respectively.
  
  
  CONCLUSIONS
  Subjects with an IRF profile have lower CAC when compared to subjects with fewer controlled risk factors. However, even among individuals with 5 to 7 IRFs, it is possible to find a CAC higher than zero reflecting that measures of IRF do not fully account for all factors that resulted in coronary artery disease.
authors.affiliation: Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil; Faculdade Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Isabela M
authors.initials: IM
authors.lastname: Bensenor
authors.affiliation: Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Alessandra C
authors.initials: AC
authors.lastname: Goulart
authors.affiliation: Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil; Faculdade Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Itamar S
authors.initials: IS
authors.lastname: Santos
authors.affiliation: Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Márcio S
authors.initials: MS
authors.lastname: Bittencourt
authors.affiliation: Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil; Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil.
authors.forename: Alexandre C
authors.initials: AC
authors.lastname: Pereira
authors.affiliation: Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil; Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital, São Paulo, Brazil.
authors.forename: Raul D
authors.initials: RD
authors.lastname: Santos
authors.affiliation: South Beach Preventive Cardiology Center, University of Miami, Miami, FL.
authors.forename: Khurram
authors.initials: K
authors.lastname: Nasir
authors.affiliation: Cardiovascular Division and Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Ron
authors.initials: R
authors.lastname: Blankstein
authors.affiliation: Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil; Faculdade Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Paulo A
authors.initials: PA
authors.lastname: Lotufo
mesh_terms: D000328:Adult; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D002114:Calcinosis / Q000175:diagnosis / Q000453:epidemiology* / Q000378:metabolism; D002118:Calcium / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000378:metabolism; D002423:Cause of Death / Q000639:trends; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000378:metabolism; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011379:Prognosis; D012016:Reference Values; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D014057:Tomography, X-Ray Computed
chemical_list: D002118:Calcium