Coronary Artery Calcium Improves Risk Assessment in Adults With a Family History of Premature Coronary Heart Disease

Abstract

Background The prognostic value of coronary artery calcium (CAC) or carotid intima-media thickness (CIMT) among asymptomatic adults with a family history (FH) of premature coronary heart disease (CHD) is unclear. Methods and Results MESA enrolled 6814 adults without known atherosclerotic cardiovascular disease (ASCVD). Hard ASCVD events were ascertained over a median follow-up of 10.2 years. We estimated adjusted-hazard ratios (HRs) across CAC and CIMT categories using Cox regression, both between and within FH status groups. Improvement in discrimination with CAC or CIMT added to variables from the ASCVD pooled-cohort equation was also evaluated using receiver operator characteristic curve and likelihood ratio analysis. Of 6125 individuals (62 ± 10 years, 47% males) who reported information on FH, 1262 (21%) had a FH of premature CHD. Among these, 104 hard ASCVD events occurred. Crude incidence-rates (per 1,000 person years) for hard ASCVD were 4.4 for CAC=0 (N=574, 46% of the sample), 8.8 for CAC 1–99 (N=368), 14.9 for CAC 100–399 (N=178), and 20.8 for CAC ≥400 (N=142). Relative to CAC=0, adjusted hard ASCVD HRs for each CAC category among persons with a FH were; 1.64 (95% CI, 0.94–2.87), 2.45 (1.31–4.58), and 2.80 (1.44–5.43), respectively. However, there was no increased hazard for hard ASCVD in high versus low CIMT categories. In participants with a FH of premature CHD, CAC improved discrimination of hard ASCVD events (p<0.001). However, CIMT did not discriminate ASCVD (p=0.70). Conclusions Nearly half of individuals reporting FH have zero CAC and may receive less net benefit from aspirin or statin therapy. Among persons with a FH, CAC is a robust marker of absolute and relative risk of ASCVD, whereas CIMT is not.

Family History of CHD Is Associated With Severe CAC in South Asians

“…Future data on incident ASCVD events in MASALA will allow further validation of the association between FH and CAC. In other ethnic groups, CAC is a robust maker of absolute and relative risk of future ASCVD among those with an FH (5). The absence of an association in CA was likely related to the low prevalence of FH in this group.…”

Subclinical macro and microvascular disease is differently associated with depressive symptoms in men and women: Findings from the SABRE population-based study

“…CAC was measured in Agatston units (AU) using a Philips 64 slice computerised tomography scanner and was categorised into four levels (0 AU, 1–100 AU, >100–400 AU, >400 AU) [ 26 ]. Far wall left common cIMT was assessed using a Philips iE33 ultrasound machine with an 11-3 MHz linear transducer.…”

Nontraditional Markers of Cardiovascular Disease Risk Can Improve the 2013 American College of Cardiology/American Heart Association Prevention Guidelines

“…The simple addition of family history to risk classification and CAC scoring appears not to be specific to a single Agatston score range (Figure). Patel and colleagues 11 have shown that Agatston scores <400 may still be relevant in subjects with a family history of premature CAD. On the low end of the CAC score spectrum, the recent Framingham analysis examined CAC scores and confirmed a score of 0 was associated with a low CVD rate of 1.6%.…”