Progression of coronary artery calcification seems to be inevitable, but predictable - results of the Heinz Nixdorf Recall (HNR) study†. (25th July 2014)

• Record Type: Journal Article
• Authors: Erbel, Raimund; Lehmann, Nils; Churzidse, Sofia; Rauwolf, Michael; Mahabadi, Amir A.; Möhlenkamp, Stefan; Moebus, Susanne; Bauer, Marcus; Kälsch, Hagen; Budde, Thomas; Montag, Michael; Schmermund, Axel; Stang, Andreas; Führer-Sakel, Dagmar; Weimar, Christian; Roggenbuck, Ulla; Dragano, Nico; Jöckel, Karl-Heinz
• Is Part Of: European heart journal. Volume 35:Number 42(2014:Nov.)
• Page Start: 2960
• Page End: 2971
• Publication Date: 2014-07-25
• Subjects: Coronary artery calcification -- Progression of atherosclerosis -- CT -- Imaging -- Heinz Nixdorf Recall study -- Epidemiology; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/ehu288
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Aim: Coronary artery calcification (CAC), as a sign of atherosclerosis, can be detected and progression quantified using computed tomography (CT). We develop a tool for predicting CAC progression. Methods and results: In 3481 participants (45–74 years, 53.1% women) CAC percentiles at baseline (CACb ) and after five years (CAC5y ) were evaluated, demonstrating progression along gender-specific percentiles, which showed exponentially shaped age-dependence. Using quantile regression on the log-scale (log(CACb +1)) we developed a tool to individually predict CAC5y, and compared to observed CAC5y . The difference between observed and predicted CAC5y (log-scale, mean±SD) was 0.08±1.11 and 0.06±1.29 in men and women. Agreement reached a kappa-value of 0.746 (95% confidence interval: 0.732–0.760) and concordance correlation (log-scale) of 0.886 (0.879–0.893). Explained variance of observed by predicted log(CAC5y +1) was 80.1% and 72.0% in men and women, and 81.0 and 73.6% including baseline risk factors. Evaluating the tool in 1940 individuals with CACb >0 and CACb <400 at baseline, of whom 242 (12.5%) developed CAC5y >400, yielded a sensitivity of 59.5%, specificity 96.1%, (+) and (−) predictive values of 68.3% and 94.3%. A pre-defined acceptance range around predicted CAC5y contained 68.1% of observed CAC5y ; only 20% were expected by chance. Age, blood pressure, lipid-lowering medication, diabetes, and smoking contributed to progression above the acceptance range in men and, excepting age, in women. Conclusion: CAC nearly inevitably progresses with limited influence of cardiovascular risk factors. This allowed the development of a mathematical tool for prediction of individual CAC progression, enabling anticipation of the age when CAC thresholds of high risk are reached.