title: Comparison of Carotid Plaque Score and Coronary Artery Calcium Score for Predicting Cardiovascular Disease Events: The Multi-Ethnic Study of Atherosclerosis.
abstract: Coronary artery calcium (CAC) predicts coronary heart disease (CHD) events better than carotid wall plaque presence; however, differences in the utility of CAC burden and carotid plaque burden across the spectrum of cardiovascular disease (CVD) events is unknown.
  
  
  
  CVD, CHD and stroke/transient ischemic attack (TIA) events were evaluated prospectively in a multiethnic cohort without CVD at baseline. Carotid plaque score was determined by the number of ultrasound-detected plaques in the common, bifurcation, and internal carotid artery segments. CAC was detected by computed tomography. Predictive values were compared using Cox proportional hazards models, C-statistics, and net reclassification, adjusting for traditional CVD risk factors. At baseline, the 4955 participants were mean (SD) 61.6 (10.1) years old and 52.8% female; 48.9% had CAC >0 and 50.8% had at least 1 carotid plaque. After 11.3 (3.0) years of follow-up, 709 CVD, 498 CHD, and 262 stroke/TIA events occurred. CAC score compared to carotid plaque score was a stronger predictor of CVD (hazard ratio [HR], 1.78; 95% CI, 1.16-1.98;P<0.001 vs HR, 1.27; 95% CI, 1.16-1.40;P<0.001) and CHD events (HR, 2.09; 95% CI, 1.84-2.38;P<0.001 vs HR, 1.35; 95% CI, 1.21-1.51;P<0.001). CAC score and carotid plaque score were weak predictors of stroke/TIA. CAC score had better reclassification statistics than carotid plaque score, except for stroke/TIA, which had similar predictive values.
  
  
  
  CAC score improved prediction, discrimination, and reclassification of CVD and CHD better than carotid ultrasound measures, although prediction and discrimination were similar for stroke/TIA.
authors.affiliation: University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Adam D
authors.initials: AD
authors.lastname: Gepner
authors.affiliation: University of Washington, Seattle, WA.
authors.forename: Rebekah
authors.initials: R
authors.lastname: Young
authors.affiliation: University of Washington, Seattle, WA.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Delaney
authors.affiliation: University of California-Los Angeles, Los Angeles, CA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Budoff
authors.affiliation: Tufts Medical Center, Boston, MA.
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Polak
authors.affiliation: Johns Hopkins University, Baltimore, MD.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Blaha
authors.affiliation: Johns Hopkins University, Baltimore, MD.
authors.forename: Wendy S
authors.initials: WS
authors.lastname: Post
authors.affiliation: Johns Hopkins University, Baltimore, MD.
authors.forename: Erin D
authors.initials: ED
authors.lastname: Michos
authors.affiliation: University of Washington, Seattle, WA.
authors.forename: Joel
authors.initials: J
authors.lastname: Kaufman
authors.affiliation: University of Wisconsin School of Medicine and Public Health, Madison, WI jhs@medicine.wisc.edu.
authors.forename: James H
authors.initials: JH
authors.lastname: Stein
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000175:diagnosis / Q000208:ethnology* / Q000209:etiology; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000208:ethnology / Q000209:etiology; D002340:Carotid Artery Diseases / Q000150:complications / Q000175:diagnosis / Q000208:ethnology*; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D015331:Cohort Studies; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000208:ethnology* / Q000209:etiology; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000378:metabolism*; D005006:Ethnicity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000150:complications / Q000175:diagnosis / Q000208:ethnology*; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D014481:United States / Q000453:epidemiology; D061205:Vascular Calcification / Q000150:complications* / Q000175:diagnosis / Q000378:metabolism
keywords: atherosclerosis; cardiovascular disease; carotid artery; imaging; risk factor