This Article Full Text Full Text (PDF) All Versions of this Article: 22/10/1674    most recent 01.ATV.0000033540.89672.24v1 Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Newman, A. B. Articles by Kuller, L. H. Search for Related Content PubMed PubMed Citation Articles by Newman, A. B. Articles by Kuller, L. H. Related Collections Peripheral vascular disease Other diagnostic testing Computerized tomography and Magnetic Resonance Imaging Epidemiology

(Arteriosclerosis, Thrombosis, and Vascular Biology. 2002;22:1674.)
© 2002 American Heart Association, Inc.

Atherosclerosis

Relationship Between Coronary Artery Calcification and Other Measures of Subclinical Cardiovascular Disease in Older Adults

Anne B. Newman; Barbara L. Naydeck; Kim Sutton-Tyrrell; Daniel Edmundowicz; Daniel O’Leary, MD; Richard Kronmal; Gregory L. Burke; Lewis H. Kuller

From the Division of Geriatric Medicine (A.B.N., B.L.N.), University of Pittsburgh, Pa; Department of Epidemiology (A.B.N., K.S.-T., L.H.K.), University of Pittsburgh, Pa; Cardiovascular Institute (D.E.), University of Pittsburgh Medical Center, Pa; Tufts-New England Medical Center (D.O.), Boston, Mass; Department of Biostatistics (R.K.), University of Washington, Seattle; and Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC.

Correspondence to Anne B. Newman, MD, MPH, University of Pittsburgh School of Medicine, Division of Geriatric Medicine, 3520 Fifth Avenue, Suite 300, Pittsburgh, PA 15213. E-mail: anewman{at}pitt.edu

Abstract

Background— In the Cardiovascular Health Study, subclinical cardiovascular disease (CVD) predicted CVD events in older adults. The extent to which this measure or its components reflect calcified coronary disease is unknown.

Methods and Results— Coronary artery calcium (CAC) was assessed with electron beam tomography in 414 participants without clinical CVD and examined using cut points (CAC400 and CAC800) and the log(CAC); 274 had subclinical CVD by ankle-arm index, ECG, or carotid ultrasound. Cut points for subclinical disease as previously defined in the Cardiovascular Health Study were examined as well as continuous measures to produce receiver operating characteristic curve curves. A low ankle-arm index was highly specific for a high CAC score. The internal carotid artery intima-media thickness was most strongly correlated with CAC (r=0.30) and was significantly related to both CAC cut points and to the log(CAC) score independently of all other measures.

Conclusions— In these community-dwelling older adults without clinical CVD, internal carotid artery intima-media thickness was most closely related to CAC. However, 17.5% of those with a CAC400 would be missed in the ascertainment of subclinical atherosclerosis using the previously published composite of subclinical atherosclerosis. Prospective follow-up will determine whether the CAC score improves prediction of CVD events over other noninvasive measures.

Key Words: coronary artery calcification • ultrafast CT scan • carotid wall thickness • subclinical cardiovascular disease • ankle-arm index

This article has been cited by other articles:

				A. Kumar, R. J. Prineas, A. M. Arnold, B. M. Psaty, C. D. Furberg, J. Robbins, and D. M. Lloyd-Jones Prevalence, Prognosis, and Implications of Isolated Minor Nonspecific ST-Segment and T-Wave Abnormalities in Older Adults: Cardiovascular Health Study Circulation, December 16, 2008; 118(25): 2790 - 2796. [Abstract] [Full Text] [PDF]

				M. Inzitari, B. L. Naydeck, and A. B. Newman Coronary Artery Calcium and Physical Function in Older Adults: The Cardiovascular Health Study J. Gerontol. A Biol. Sci. Med. Sci., October 1, 2008; 63(10): 1112 - 1118. [Abstract] [Full Text] [PDF]

				A. R. Folsom, R. A. Kronmal, R. C. Detrano, D. H. O'Leary, D. E. Bild, D. A. Bluemke, M. J. Budoff, K. Liu, S. Shea, M. Szklo, et al. Coronary Artery Calcification Compared With Carotid Intima-Media Thickness in the Prediction of Cardiovascular Disease Incidence: The Multi-Ethnic Study of Atherosclerosis (MESA) Arch Intern Med, June 23, 2008; 168(12): 1333 - 1339. [Abstract] [Full Text] [PDF]

				E. R. Brown, R. A. Kronmal, D. A. Bluemke, A. D. Guerci, J. J. Carr, J. Goldin, and R. Detrano Coronary Calcium Coverage Score: Determination, Correlates, and Predictive Accuracy in the Multi-Ethnic Study of Atherosclerosis Radiology, June 1, 2008; 247(3): 669 - 675. [Abstract] [Full Text] [PDF]

				M. Terashima, P. K. Nguyen, G. D. Rubin, C. Iribarren, B. K. Courtney, A. S. Go, S. P. Fortmann, and M. V. McConnell Impaired coronary vasodilation by magnetic resonance angiography is associated with advanced coronary artery calcification. J. Am. Coll. Cardiol. Img., March 1, 2008; 1(2): 167 - 173. [Abstract] [Full Text] [PDF]

				F. Bamberg, N. Dannemann, M. D. Shapiro, S. K. Seneviratne, M. Ferencik, J. Butler, W. Koenig, K. Nasir, R. C. Cury, A. Tawakol, et al. Association Between Cardiovascular Risk Profiles and the Presence and Extent of Different Types of Coronary Atherosclerotic Plaque as Detected by Multidetector Computed Tomography Arterioscler Thromb Vasc Biol, March 1, 2008; 28(3): 568 - 574. [Abstract] [Full Text] [PDF]

				P. Poredos and B. Jug The Prevalence of Peripheral Arterial Disease in High Risk Subjects and Coronary or Cerebrovascular Patients Angiology, July 1, 2007; 58(3): 309 - 315. [Abstract] [PDF]

				M. L. Bots, D. Baldassarre, A. Simon, E. de Groot, D. H. O'Leary, W. Riley, J. J. Kastelein, and D. E. Grobbee Carotid intima-media thickness and coronary atherosclerosis: weak or strong relations? Eur. Heart J., February 2, 2007; 28(4): 398 - 406. [Abstract] [Full Text] [PDF]

				S. J. Nicholls, E. M. Tuzcu, T. Crowe, I. Sipahi, P. Schoenhagen, S. Kapadia, S. L. Hazen, C.-C. Wun, M. Norton, F. Ntanios, et al. Relationship Between Cardiovascular Risk Factors and Atherosclerotic Disease Burden Measured by Intravascular Ultrasound J. Am. Coll. Cardiol., May 16, 2006; 47(10): 1967 - 1975. [Abstract] [Full Text] [PDF]

				A. R. Folsom, G. W. Evans, J. J. Carr, A. E. Stillman, and Atherosclerosis Risk in Communities (ARIC) Study I Association of Traditional and Nontraditional Cardiovascular Risk Factors with Coronary Artery Calcification Angiology, November 1, 2004; 55(6): 613 - 623. [Abstract] [PDF]

				A. R. Folsom, G. W. Evans, J. J. Carr, A. E. Stillman, and Atherosclerosis Risk in Communities (ARIC) Study I Association of Traditional and Nontraditional Cardiovascular Risk Factors with Coronary Artery Calcification Angiology, November 1, 2004; 55(6): 613 - 623. [Abstract] [PDF]

				T. Jain, R. Peshock, D. K. McGuire, D. Willett, Z. Yu, G. L. Vega, R. Guerra, H. H. Hobbs, S. M. Grundy, and the Dallas Heart Study Investigators African Americans and Caucasians have a similar prevalence of coronary calcium in the Dallas Heart Study J. Am. Coll. Cardiol., September 1, 2004; 44(5): 1011 - 1017. [Abstract] [Full Text] [PDF]

				L. E. Wagenknecht, C. D. Langefeld, J. J. Carr, W. Riley, B. I. Freedman, S. Moossavi, and D. W. Bowden Race-Specific Relationships Between Coronary and Carotid Artery Calcification and Carotid Intimal Medial Thickness Stroke, May 1, 2004; 35(5): e97 - e99. [Abstract] [Full Text] [PDF]

				H. Tiemeier, W. van Dijck, A. Hofman, J. C. M. Witteman, T. Stijnen, and M. M. B. Breteler Relationship Between Atherosclerosis and Late-Life Depression: The Rotterdam Study Arch Gen Psychiatry, April 1, 2004; 61(4): 369 - 376. [Abstract] [Full Text] [PDF]