Implication of thoracic aortic calcification over coronary calcium score regarding the 2018 ACC/AHA Multisociety cholesterol guideline: results from the CAC Consortium
Objective: TAC is associated with an increased atherosclerotic cardiovascular disease (ASCVD) risk, but it is unclear how to interpret thoracic aortic calcification (TAC) findings in conjunction with ASCVD risk and coronary artery calcium (CAC) score according to 2018 ACC/AHA Multisociety cholestero...
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Format: | Article |
Language: | English |
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Elsevier
2021-12-01
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Series: | American Journal of Preventive Cardiology |
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Online Access: | http://www.sciencedirect.com/science/article/pii/S2666667721000878 |
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doaj-03fc0bc52a8741b9b97ff6358b0f575d |
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record_format |
Article |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Donghee Han Keiichiro Kuronuma Alan Rozanski Matthew J Budoff Michael D Miedema Khurram Nasir Leslee J Shaw John A Rumberger Heidi Gransar Roger S Blumenthal Michael J Blaha Daniel S Berman |
spellingShingle |
Donghee Han Keiichiro Kuronuma Alan Rozanski Matthew J Budoff Michael D Miedema Khurram Nasir Leslee J Shaw John A Rumberger Heidi Gransar Roger S Blumenthal Michael J Blaha Daniel S Berman Implication of thoracic aortic calcification over coronary calcium score regarding the 2018 ACC/AHA Multisociety cholesterol guideline: results from the CAC Consortium American Journal of Preventive Cardiology Thoracic aortic calcification Coronary artery calcium Prognosis Cardiovascular mortality Computed tomography |
author_facet |
Donghee Han Keiichiro Kuronuma Alan Rozanski Matthew J Budoff Michael D Miedema Khurram Nasir Leslee J Shaw John A Rumberger Heidi Gransar Roger S Blumenthal Michael J Blaha Daniel S Berman |
author_sort |
Donghee Han |
title |
Implication of thoracic aortic calcification over coronary calcium score regarding the 2018 ACC/AHA Multisociety cholesterol guideline: results from the CAC Consortium |
title_short |
Implication of thoracic aortic calcification over coronary calcium score regarding the 2018 ACC/AHA Multisociety cholesterol guideline: results from the CAC Consortium |
title_full |
Implication of thoracic aortic calcification over coronary calcium score regarding the 2018 ACC/AHA Multisociety cholesterol guideline: results from the CAC Consortium |
title_fullStr |
Implication of thoracic aortic calcification over coronary calcium score regarding the 2018 ACC/AHA Multisociety cholesterol guideline: results from the CAC Consortium |
title_full_unstemmed |
Implication of thoracic aortic calcification over coronary calcium score regarding the 2018 ACC/AHA Multisociety cholesterol guideline: results from the CAC Consortium |
title_sort |
implication of thoracic aortic calcification over coronary calcium score regarding the 2018 acc/aha multisociety cholesterol guideline: results from the cac consortium |
publisher |
Elsevier |
series |
American Journal of Preventive Cardiology |
issn |
2666-6677 |
publishDate |
2021-12-01 |
description |
Objective: TAC is associated with an increased atherosclerotic cardiovascular disease (ASCVD) risk, but it is unclear how to interpret thoracic aortic calcification (TAC) findings in conjunction with ASCVD risk and coronary artery calcium (CAC) score according to 2018 ACC/AHA Multisociety cholesterol guidelines. We evaluate the incremental value of thoracic aortic calcification TAC over CAC for predicting and reclassifying ASCVD mortality risk. Method: The study included 30,630 asymptomatic individuals (mean age: 55 ± 8 years, male: 64%) from the CAC Consortium. TAC was categorized as TAC 0, 1-300, and >300. Patients were categorized as low (<5%), borderline (5–7.5%), intermediate (7.5–20%), or high (≥20%) 10-year ASCVD risk according to the Pooled Cohorts Equation. In the intermediate risk group, the utility of TAC beyond CAC for statin eligibility was assessed according to the guideline. CAC was categorized as CAC=0 (no statin), CAC 1-100 (favors statin), or CAC>100 (initiate stain). Results: During the median 11.2 years (IQR 9.2–12.4) follow-up, 345 (1.1%) CVD deaths occurred. TAC>300 was associated with increased CVD mortality after adjusting for ASCVD risk and CAC (HR:4.72, 95% CI: 3.39–6.57, p<0.001). In borderline and intermediate risk groups, TAC improved discrimination when added to a model included ASCVD risk and CAC (C-statistic: 0.77 vs. 0.68 in borderline group; 0.67 vs. 0.63 in intermediate group, both p < 0.05). The addition of TAC over CAC improved risk reclassification in borderline, intermediate and high-risk groups (categorical net reclassification index: 0.40, 0.29, and 0.49, respectively, all p < 0.001). Of intermediate risk participants for whom consideration of CAC was recommended based on the guideline, TAC >300 was associated with an increased CVD mortality risk across each statin eligibility group (all p < 0.001, compared to TAC 0). Conclusion: TAC was independently associated with CVD death. Among individuals with borderline or intermediate ASCVD risk, a TAC threshold of 300 may provide added prognostic and reclassification value beyond the current guideline-based approach. |
topic |
Thoracic aortic calcification Coronary artery calcium Prognosis Cardiovascular mortality Computed tomography |
url |
http://www.sciencedirect.com/science/article/pii/S2666667721000878 |
work_keys_str_mv |
AT dongheehan implicationofthoracicaorticcalcificationovercoronarycalciumscoreregardingthe2018accahamultisocietycholesterolguidelineresultsfromthecacconsortium AT keiichirokuronuma implicationofthoracicaorticcalcificationovercoronarycalciumscoreregardingthe2018accahamultisocietycholesterolguidelineresultsfromthecacconsortium AT alanrozanski implicationofthoracicaorticcalcificationovercoronarycalciumscoreregardingthe2018accahamultisocietycholesterolguidelineresultsfromthecacconsortium AT matthewjbudoff implicationofthoracicaorticcalcificationovercoronarycalciumscoreregardingthe2018accahamultisocietycholesterolguidelineresultsfromthecacconsortium AT michaeldmiedema implicationofthoracicaorticcalcificationovercoronarycalciumscoreregardingthe2018accahamultisocietycholesterolguidelineresultsfromthecacconsortium AT khurramnasir implicationofthoracicaorticcalcificationovercoronarycalciumscoreregardingthe2018accahamultisocietycholesterolguidelineresultsfromthecacconsortium AT lesleejshaw implicationofthoracicaorticcalcificationovercoronarycalciumscoreregardingthe2018accahamultisocietycholesterolguidelineresultsfromthecacconsortium AT johnarumberger implicationofthoracicaorticcalcificationovercoronarycalciumscoreregardingthe2018accahamultisocietycholesterolguidelineresultsfromthecacconsortium AT heidigransar implicationofthoracicaorticcalcificationovercoronarycalciumscoreregardingthe2018accahamultisocietycholesterolguidelineresultsfromthecacconsortium AT rogersblumenthal implicationofthoracicaorticcalcificationovercoronarycalciumscoreregardingthe2018accahamultisocietycholesterolguidelineresultsfromthecacconsortium AT michaeljblaha implicationofthoracicaorticcalcificationovercoronarycalciumscoreregardingthe2018accahamultisocietycholesterolguidelineresultsfromthecacconsortium AT danielsberman implicationofthoracicaorticcalcificationovercoronarycalciumscoreregardingthe2018accahamultisocietycholesterolguidelineresultsfromthecacconsortium |
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1721201599784681472 |
spelling |
doaj-03fc0bc52a8741b9b97ff6358b0f575d2021-08-20T04:36:42ZengElsevierAmerican Journal of Preventive Cardiology2666-66772021-12-018100232Implication of thoracic aortic calcification over coronary calcium score regarding the 2018 ACC/AHA Multisociety cholesterol guideline: results from the CAC ConsortiumDonghee Han0Keiichiro Kuronuma1Alan Rozanski2Matthew J Budoff3Michael D Miedema4Khurram Nasir5Leslee J Shaw6John A Rumberger7Heidi Gransar8Roger S Blumenthal9Michael J Blaha10Daniel S Berman11Department of Imaging and Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA 90048, United StatesDepartment of Imaging and Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA 90048, United StatesDivision of Cardiology, Mount Sinai St. Luke's Hospital, New York, United StatesDepartment of Medicine, Harbor-UCLA Medical Center, University of California Los Angeles, Los Angeles, CA, United StatesMinneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN, United StatesDivision Cardiovascular Prevention and Wellness, Houston Methodist Hospital, Houston, TX, United StatesDepartment of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York United StatesPrinceton Longevity Center, Princeton, NJ, United StatesDepartment of Imaging and Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA 90048, United StatesJohns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University, Baltimore, MD, United StatesJohns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University, Baltimore, MD, United StatesDepartment of Imaging and Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA 90048, United States; Corresponding author.Objective: TAC is associated with an increased atherosclerotic cardiovascular disease (ASCVD) risk, but it is unclear how to interpret thoracic aortic calcification (TAC) findings in conjunction with ASCVD risk and coronary artery calcium (CAC) score according to 2018 ACC/AHA Multisociety cholesterol guidelines. We evaluate the incremental value of thoracic aortic calcification TAC over CAC for predicting and reclassifying ASCVD mortality risk. Method: The study included 30,630 asymptomatic individuals (mean age: 55 ± 8 years, male: 64%) from the CAC Consortium. TAC was categorized as TAC 0, 1-300, and >300. Patients were categorized as low (<5%), borderline (5–7.5%), intermediate (7.5–20%), or high (≥20%) 10-year ASCVD risk according to the Pooled Cohorts Equation. In the intermediate risk group, the utility of TAC beyond CAC for statin eligibility was assessed according to the guideline. CAC was categorized as CAC=0 (no statin), CAC 1-100 (favors statin), or CAC>100 (initiate stain). Results: During the median 11.2 years (IQR 9.2–12.4) follow-up, 345 (1.1%) CVD deaths occurred. TAC>300 was associated with increased CVD mortality after adjusting for ASCVD risk and CAC (HR:4.72, 95% CI: 3.39–6.57, p<0.001). In borderline and intermediate risk groups, TAC improved discrimination when added to a model included ASCVD risk and CAC (C-statistic: 0.77 vs. 0.68 in borderline group; 0.67 vs. 0.63 in intermediate group, both p < 0.05). The addition of TAC over CAC improved risk reclassification in borderline, intermediate and high-risk groups (categorical net reclassification index: 0.40, 0.29, and 0.49, respectively, all p < 0.001). Of intermediate risk participants for whom consideration of CAC was recommended based on the guideline, TAC >300 was associated with an increased CVD mortality risk across each statin eligibility group (all p < 0.001, compared to TAC 0). Conclusion: TAC was independently associated with CVD death. Among individuals with borderline or intermediate ASCVD risk, a TAC threshold of 300 may provide added prognostic and reclassification value beyond the current guideline-based approach.http://www.sciencedirect.com/science/article/pii/S2666667721000878Thoracic aortic calcificationCoronary artery calciumPrognosisCardiovascular mortalityComputed tomography |