title: Greater Volume but not Higher Density of Abdominal Aortic Calcium Is Associated With Increased Cardiovascular Disease Risk: MESA (Multi-Ethnic Study of Atherosclerosis).
abstract: BACKGROUND
  Abdominal aortic calcium (AAC) and coronary artery calcium (CAC) independently and similarly predict cardiovascular disease (CVD) events. The standard AAC and CAC score, the Agatston method, upweights for greater calcium density, thereby modeling higher calcium density as a CVD hazard.
  
  
  RESULTS
  Computed tomography scans were used to measure AAC and CAC volume and density in a multiethnic cohort of community-dwelling individuals, and Cox proportional hazard was used to determine their independent association with incident coronary heart disease (CHD, defined as myocardial infarction, resuscitated cardiac arrest, or CHD death), cardiovascular disease (CVD, defined as CHD plus stroke and stroke death), and all-cause mortality. In 997 participants with Agatston AAC and CAC scores >0, the mean age was 66±9 years, and 58% were men. During an average follow-up of 9 years, there were 77 CHD, 118 CVD, and 169 all-cause mortality events. In mutually adjusted models, additionally adjusted for CVD risk factors, an increase in ln(AAC volume) per standard deviation was significantly associated with increased all-cause mortality (hazard ratio=1.20; 95% confidence interval, 1.08-1.33; P<0.01) and an increased ln(CAC volume) per standard deviation was significantly associated with CHD (hazard ratio=1.17; 95% confidence interval, 1.04-1.59; P=0.02) and CVD (hazard ratio=1.20; 95% confidence interval, 1.05-1.36; P<0.01). In contrast, both AAC and CAC density were not significantly associated with CVD events.
  
  
  CONCLUSIONS
  The Agatston method of upweighting calcium scores for greater density may be inappropriate for CVD risk prediction in both the abdominal aorta and coronary arteries.
authors.affiliation: From the Department of Family Medicine and Public Health, University of California, San Diego, La Jolla (N.I.F., R.A.R.-B., M.A.A., J.H.I., I.T., D.E.R., M.H.C.); Department of Medicine, Johns Hopkins University, Baltimore, MD (E.D.M.); Department of Biostatistics, University of Washington, Seattle (R.L.M.); Veterans Administration San Diego Healthcare System, La Jolla, CA (M.A.A., J.H.I., D.E.R.); and Clinical Center, National Institutes of Health, Bethesda, MD (V.S.). nforbang@gmail.com.
authors.forename: Nketi I
authors.initials: NI
authors.lastname: Forbang
authors.affiliation: From the Department of Family Medicine and Public Health, University of California, San Diego, La Jolla (N.I.F., R.A.R.-B., M.A.A., J.H.I., I.T., D.E.R., M.H.C.); Department of Medicine, Johns Hopkins University, Baltimore, MD (E.D.M.); Department of Biostatistics, University of Washington, Seattle (R.L.M.); Veterans Administration San Diego Healthcare System, La Jolla, CA (M.A.A., J.H.I., D.E.R.); and Clinical Center, National Institutes of Health, Bethesda, MD (V.S.).
authors.forename: Erin D
authors.initials: ED
authors.lastname: Michos
authors.affiliation: From the Department of Family Medicine and Public Health, University of California, San Diego, La Jolla (N.I.F., R.A.R.-B., M.A.A., J.H.I., I.T., D.E.R., M.H.C.); Department of Medicine, Johns Hopkins University, Baltimore, MD (E.D.M.); Department of Biostatistics, University of Washington, Seattle (R.L.M.); Veterans Administration San Diego Healthcare System, La Jolla, CA (M.A.A., J.H.I., D.E.R.); and Clinical Center, National Institutes of Health, Bethesda, MD (V.S.).
authors.forename: Robyn L
authors.initials: RL
authors.lastname: McClelland
authors.affiliation: From the Department of Family Medicine and Public Health, University of California, San Diego, La Jolla (N.I.F., R.A.R.-B., M.A.A., J.H.I., I.T., D.E.R., M.H.C.); Department of Medicine, Johns Hopkins University, Baltimore, MD (E.D.M.); Department of Biostatistics, University of Washington, Seattle (R.L.M.); Veterans Administration San Diego Healthcare System, La Jolla, CA (M.A.A., J.H.I., D.E.R.); and Clinical Center, National Institutes of Health, Bethesda, MD (V.S.).
authors.forename: Rosemay A
authors.initials: RA
authors.lastname: Remigio-Baker
authors.affiliation: From the Department of Family Medicine and Public Health, University of California, San Diego, La Jolla (N.I.F., R.A.R.-B., M.A.A., J.H.I., I.T., D.E.R., M.H.C.); Department of Medicine, Johns Hopkins University, Baltimore, MD (E.D.M.); Department of Biostatistics, University of Washington, Seattle (R.L.M.); Veterans Administration San Diego Healthcare System, La Jolla, CA (M.A.A., J.H.I., D.E.R.); and Clinical Center, National Institutes of Health, Bethesda, MD (V.S.).
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Allison
authors.affiliation: From the Department of Family Medicine and Public Health, University of California, San Diego, La Jolla (N.I.F., R.A.R.-B., M.A.A., J.H.I., I.T., D.E.R., M.H.C.); Department of Medicine, Johns Hopkins University, Baltimore, MD (E.D.M.); Department of Biostatistics, University of Washington, Seattle (R.L.M.); Veterans Administration San Diego Healthcare System, La Jolla, CA (M.A.A., J.H.I., D.E.R.); and Clinical Center, National Institutes of Health, Bethesda, MD (V.S.).
authors.forename: Veit
authors.initials: V
authors.lastname: Sandfort
authors.affiliation: From the Department of Family Medicine and Public Health, University of California, San Diego, La Jolla (N.I.F., R.A.R.-B., M.A.A., J.H.I., I.T., D.E.R., M.H.C.); Department of Medicine, Johns Hopkins University, Baltimore, MD (E.D.M.); Department of Biostatistics, University of Washington, Seattle (R.L.M.); Veterans Administration San Diego Healthcare System, La Jolla, CA (M.A.A., J.H.I., D.E.R.); and Clinical Center, National Institutes of Health, Bethesda, MD (V.S.).
authors.forename: Joachim H
authors.initials: JH
authors.lastname: Ix
authors.affiliation: From the Department of Family Medicine and Public Health, University of California, San Diego, La Jolla (N.I.F., R.A.R.-B., M.A.A., J.H.I., I.T., D.E.R., M.H.C.); Department of Medicine, Johns Hopkins University, Baltimore, MD (E.D.M.); Department of Biostatistics, University of Washington, Seattle (R.L.M.); Veterans Administration San Diego Healthcare System, La Jolla, CA (M.A.A., J.H.I., D.E.R.); and Clinical Center, National Institutes of Health, Bethesda, MD (V.S.).
authors.forename: Isac
authors.initials: I
authors.lastname: Thomas
authors.affiliation: From the Department of Family Medicine and Public Health, University of California, San Diego, La Jolla (N.I.F., R.A.R.-B., M.A.A., J.H.I., I.T., D.E.R., M.H.C.); Department of Medicine, Johns Hopkins University, Baltimore, MD (E.D.M.); Department of Biostatistics, University of Washington, Seattle (R.L.M.); Veterans Administration San Diego Healthcare System, La Jolla, CA (M.A.A., J.H.I., D.E.R.); and Clinical Center, National Institutes of Health, Bethesda, MD (V.S.).
authors.forename: Dena E
authors.initials: DE
authors.lastname: Rifkin
authors.affiliation: From the Department of Family Medicine and Public Health, University of California, San Diego, La Jolla (N.I.F., R.A.R.-B., M.A.A., J.H.I., I.T., D.E.R., M.H.C.); Department of Medicine, Johns Hopkins University, Baltimore, MD (E.D.M.); Department of Biostatistics, University of Washington, Seattle (R.L.M.); Veterans Administration San Diego Healthcare System, La Jolla, CA (M.A.A., J.H.I., D.E.R.); and Clinical Center, National Institutes of Health, Bethesda, MD (V.S.).
authors.forename: Michael H
authors.initials: MH
authors.lastname: Criqui
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging*; D001018:Aortic Diseases / Q000000981:diagnostic imaging* / Q000208:ethnology / Q000401:mortality; D001027:Aortography / Q000379:methods*; D050197:Atherosclerosis / Q000000981:diagnostic imaging* / Q000208:ethnology / Q000401:mortality; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000208:ethnology / Q000401:mortality; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005260:Female; D006323:Heart Arrest / Q000208:ethnology / Q000401:mortality / Q000628:therapy; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000208:ethnology / Q000401:mortality; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011857:Radiographic Image Interpretation, Computer-Assisted; D012151:Resuscitation; D012307:Risk Factors; D020521:Stroke / Q000208:ethnology / Q000401:mortality; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D061205:Vascular Calcification / Q000000981:diagnostic imaging* / Q000208:ethnology / Q000401:mortality
keywords: abdominal aorta; atherosclerosis; cardiovascular disease; computed tomography; coronary arteries; coronary heart disease