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Cited by 642Cardiac Imaging and DiagnosticsCardiovascular Disease and AdiposityDiabetes, Cardiovascular Risks, and Lipoproteins

Calcium Density of Coronary Artery Plaque and Risk of Incident Cardiovascular Events

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Criqui, Michael H., Denenberg, Julie O., Ix, Joachim H., McClelland, Robyn L., Wassel, Christina L., Rifkin, Dena E., Carr, Jeffrey J., Budoff, Matthew J. +1 more·2014·JAMA
DOI 10.1001/jama.2013.282535PMC PMC4091626
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Abstract

IMPORTANCE: Coronary artery calcium (CAC), measured by computed tomography (CT), has strong predictive value for incident cardiovascular disease (CVD) events. The standard CAC score is the Agatston, which is weighted upward for greater calcium density. However, some data suggest increased plaque calcium density may be protective for CVD. OBJECTIVE: To determine the independent associations of CAC volume and CAC density with incident CVD events. DESIGN, SETTING, AND PARTICIPANTS: Multicenter, prospective observational MESA study (Multi-Ethnic Study of Atherosclerosis), conducted at 6 US field centers of 3398 men and women from 4 race/ethnicity groups; non-Hispanic white, African American, Hispanic, and Chinese. Participants were aged 45-84 years, free of known CVD at baseline, had CAC greater than 0 on their baseline CT, and were followed up through October 2010. MAIN OUTCOMES AND MEASURES: Incident coronary heart disease (CHD) and all CVD events RESULTS: During a median of 7.6 years of follow-up, there were 175 CHD events and an additional 90 other CVD events for a total of 265 CVD events. With both lnCAC volume and CAC density scores in the same multivariable model, the lnCAC volume score showed an independent association with incident CHD, with a hazard ratio (HR) of 1.81 (95% CI, 1.47-2.23) per standard deviation (SD = 1.6) increase, absolute risk increase 6.1 per 1000 person-years, and for CVD an HR of 1.68 (95% CI, 1.42-1.98) per SD increase, absolute risk increase 7.9 per 1000 person-years. Conversely, the CAC density score showed an independent inverse association, with an HR of 0.73 (95% CI, 0.58-0.91) per SD (SD = 0.7) increase for CHD, absolute risk decrease 5.5 per 1000 person-years, and an HR of 0.71 (95% CI, 0.60-0.85) per SD increase for CVD, absolute risk decrease 8.2 per 1000 person years. Area under the receiver operating characteristic curve analyses showed significantly improved risk prediction with the addition of the density score to a model containing the volume score for both CHD and CVD. In the intermediate CVD risk group, the area under the curve for CVD increased from 0.53 (95% CI, 0.48-0.59) to 0.59 (95% CI, 0.54-0.64), P = .02. CONCLUSIONS AND RELEVANCE: CAC volume was positively and independently associated with CHD and CVD risk. At any level of CAC volume, CAC density was inversely and significantly associated with CHD and CVD risk. The role of CAC density should be considered when evaluating current CAC scoring systems.

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  • An increase in coronary artery calcium area increases the risk of cardiovascular events, whereas an increase in density lowers the risk of cardiovascular events.

    “The CAC score is a multiplication of area and density, whereby an increase in area increases the risk of cardiovascular events and an increase in density lowers the risk of cardiovascular events 19 .”

    From Relationship between lifelong exercise volume and coronary atherosclerosis in athletes. (2017) · cites this paper as [19]

  • A high CAC area is directly associated with CVD risk, but increased density of CAC is inversely associated with CVD risk.

    “Others have shown that a high CAC area is directly associated with CVD risk, but that increased density of CAC is inversely associated with CVD risk 19”

    From Relationship between lifelong exercise volume and coronary atherosclerosis in athletes. (2017) · cites this paper as [19]

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Research works printed but not linked: 28

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Authors
Criqui, M. H., Denenberg, J. O., Ix, J. H., McClelland, R. L., Wassel, C. L., Rifkin, D. E., Carr, J. J., Budoff, M. J., & Allison, M. A.
Affiliations
  • University of California San Diego (US)
  • University of Washington (US)
  • University of Pittsburgh (US)
  • Vanderbilt University (US)
  • The Lundquist Institute (US)
Corresponding author
Criqui, Michael H.
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2014-01-15
Volume
311
Issue
3
Pages
271
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.2013.282535
PMC
PMC4091626
OpenAlex
W2014951154
Cited by
642
References
3
Citations by year
2026: 28 · 2025: 38 · 2024: 60 · 2023: 60 · 2022: 60 · 2021: 72 · 2020: 71 · 2019: 41 · 2018: 49 · 2017: 38 · 2016: 58 · 2015: 44 · 2014: 20 · 2013: 3
FWCI
32.34
Type
journal article
Language
en
Open access
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • National Institutes of Health (n01hc95164-17-0-1, n01hc95165-34-0-1, n01hc95161-24-0-1, n01hc095169-003, n01hc95162-31-0-1, n01hc95160-18-0-1, n01hc95163-22-0-1, n01hc95159-40-0-1)
  • National Heart, Lung, and Blood Institute (N01 HC-95159, N01-HC-95160, N01-HC095169, N01-HC-095165, (N01-HC-95163, N01 HC095163, N01 HC-95161, N01 HC95165, N01HC95164, N01-HC-095159, N01-HC-095162, N01-HC-095161, N01-HC-095160, N01 HC095164, N01 HC-95162, N01 HC95169)
  • National Institute of Diabetes and Digestive and Kidney Diseases (K23DK091521)
Topics
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Disease and Adiposity
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
coronary artery calcium, calcium density, coronary plaque, coronary artery disease, cardiovascular events, Agatston score, Multi-Ethnic Study of Atherosclerosis, risk prediction, racial and ethnic differences, atherosclerosis, risk reclassification, risk calibration, risk mitigation, risk discrimination
MeSH terms
Aged, Aged, 80 and over, Calcium, Coronary Disease, Coronary Vessels, Female, Humans, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, Reference Values, Risk, Tomography, X-Ray Computed, Atherosclerosis, Plaque, Atherosclerotic

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