Arterial calcification at different sites and prediction of atherosclerotic cardiovascular disease among women and men. (November 2021)

• Record Type: Journal Article
• Authors: van der Toorn, Janine E.; Bos, Daniel; Arshi, Banafsheh; Leening, Maarten J.G.; Vernooij, Meike W.; Ikram, M. Arfan; Ikram, M. Kamran; Kavousi, Maryam
• Is Part Of: Atherosclerosis. Volume 337(2021)
• Page Start: 27
• Page End: 34
• Publication Date: 2021-11
• Subjects: Vascular calcification -- Multidetector computed tomography -- Cardiovascular diseases -- Risk assessment -- Epidemiology; Arteriosclerosis -- Periodicals; Electronic journals; 616.136
• DOI: 10.1016/j.atherosclerosis.2021.10.009
• Languages: English
• ISSNs: 0021-9150

Abstract

Abstract: Background and aims: The sex-specific contributions of arterial calcification to atherosclerotic cardiovascular disease (ASCVD) risk prediction and stratification in the light of recent modifications by cardiovascular prevention guidelines remain unclear. We assessed the sex-specific value of calcification in different arteries, beyond the Pooled Cohort Equations (PCE) risk factors, for 10-year ASCVD risk prediction. Methods: From 2003 to 2006, participants from the population-based Rotterdam Study (n = 2167) underwent CT to quantify coronary artery calcification (CAC), aortic arch calcification (AAC), extracranial (ECAC) and intracranial carotid artery calcification (ICAC). Follow-up for ASCVD was complete on January 1, 2015. We refitted the PCE (base model), and categorized participants into low (<5%), borderline (5%–7.5%), intermediate (7.5%–20%), and high (≥20%) ASCVD risk. We extended the models with calcifications and calculated c-statistics and net reclassification improvements for events (NRIe ) and non-events (NRIne ). Results: CAC predicted ASCVD in women [hazard-ratio (95%-CI) per 1-SD: 1.40 (1.14–1.73)] and men [1.62 (1.27–1.93)]. After addition of CAC to the base model, the c-statistic improved from 0.71 to 0.72 in women; from 0.65 to 0.68 in men. Addition of CAC led to NRIe of 14.3% in women, 4.8% in men and NRIne of 1.5% in women, 15.1% in men. Only in women, ICAC predicted ASCVD [hazard-ratio (95%-CI) per 1-SD: 1.62 (1.26–2.08)], and improved the model (c-statistic from 0.71 to 0.73, NRIe : 9.8% and NRIne : 5.9%). Conclusions: Assessment of CAC improves ASCVD risk prediction and stratification. In women, the added value of ICAC for ASCVD risk prediction is comparable to that of CAC. Graphical abstract: Image 1 Highlights: Coronary artery calcification (CAC) improves prediction and restratification of atherosclerotic cardiovascular disease (ASCVD) across sex-strata. In women, the added value of intracranial carotid artery calcification (ICAC) is comparable to that of CAC. Studies should further assess the clinical relevance of ICAC in women.