Comparing coronary artery calcium and thoracic aorta calcium for prediction of all-cause mortality and cardiovascular events on low-dose non-gated computed tomography in a high-risk population of heavy smokers

Peter C. Jacobs*, Mathias Prokop, Yolanda van der Graaf, Martijn J. Gondrie, Kristel J. Janssen, Harry J. de Koning, Ivana Isgum, Rob J. van Klaveren, Matthijs Oudkerk, Bram van Ginneken, Willem P. Mali

*Corresponding author for this work

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    Abstract

    Background: Coronary artery calcium (CAC) and thoracic aorta calcium (TAC) can be detected simultaneously on low-dose, non-gated computed tomography (CT) scans. CAC has been shown to predict cardiovascular (CVD) and coronary (CHD) events. A comparable association between TAC and CVD events has yet to be established, but TAC could be a more reproducible alternative to CAC in low-dose, non-gated CT. This study compared CAC and TAC as independent predictors of all-cause mortality and cardiovascular events in a population of heavy smokers using low-dose, non-gated CT.

    Methods: Within the NELSON study, a population-based lung cancer screening trial, the CT screen group consisted of 7557 heavy smokers aged 50-75 years. Using a case-cohort study design, CAC and TAC scores were calculated in a total of 958 asymptomatic subjects who were followed up for all-cause death, and CVD, CHD and non-cardiac events (stroke, aortic aneurysm, peripheral arterial occlusive disease). We used Cox proportional-hazard regression to compute hazard ratios (HRs) with adjustment for traditional cardiovascular risk factors.

    Results: A close association between the prevalence of TAC and increasing levels of CAC was established (p <0.001). Increasing CAC and TAC risk categories were associated with all-cause mortality (p for trend = 0.01 and 0.001, respectively) and CVD events (p for trend <0.001 and 0.03, respectively). Compared with the lowest quartile (reference category), multivariate-adjusted HRs across categories of CAC were higher (all-cause mortality, HR: 9.13 for highest quartile; CVD events, HR: 4.46 for highest quartile) than of TAC scores (HR: 5.45 and HR: 2.25, respectively). However, TAC is associated with non-coronary events (HR: 4.69 for highest quartile, p for trend = 0.01) and CAC was not (HR: 3.06 for highest quartile, p for trend = 0.40).

    Conclusions: CAC was found to be a stronger predictor than TAC of all-cause mortality and CVD events in a high-risk population of heavy smokers scored on low-dose, non-gated CT. TAC, however, is stronger associated with non-cardiac events than CAC and could prove to be a preferred marker for these events. (C) 2009 Elsevier Ireland Ltd. All rights reserved.

    Original languageEnglish
    Pages (from-to)455-462
    Number of pages8
    JournalATHEROSCLEROSIS
    Volume209
    Issue number2
    DOIs
    Publication statusPublished - Apr-2010

    Keywords

    • Cardiovascular diseases
    • Coronary artery calcium
    • Thoracic aortic calcium
    • Follow-up studies
    • Computed tomography
    • GENERAL-POPULATION
    • HEART-DISEASE
    • CALCIFICATION
    • ATHEROSCLEROSIS
    • ASSOCIATION
    • CT
    • COHORT
    • PLAQUE
    • MESA

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