Thoracic Aortic Calcium Density and Area in Long-Term Atherosclerotic Cardiovascular Disease Risk Among Men Versus Women-Reference-Cited by-同舟云学术

Thoracic Aortic Calcium Density and Area in Long-Term Atherosclerotic Cardiovascular Disease Risk Among Men Versus Women

Published:2023-12 Issue:12 Volume:16 Page:
ISSN:1941-9651
Container-title:Circulation: Cardiovascular Imaging
language:en
Short-container-title:Circ: Cardiovascular Imaging

Author:

Razavi Alexander C.¹²^ORCID,Kim Cherry²³^ORCID,van Assen Marly²^ORCID,De Cecco Carlo N.²^ORCID,Berman Daniel S.⁴^ORCID,Budoff Matthew J.⁵^ORCID,Quyyumi Arshed A.¹^ORCID,Vaccarino Viola¹^ORCID,Miedema Michael D.⁶^ORCID,Nasir Khurram⁷^ORCID,Rozanski Alan⁸,Fernandez Camilo⁹,Rumberger John A.¹⁰^ORCID,Shaw Leslee J.¹⁰^ORCID,Bødtker Mortensen Martin¹¹^ORCID,Wong Nathan D.¹²^ORCID,Blumenthal Roger S.¹³^ORCID,Sperling Laurence S.¹^ORCID,Whelton Seamus P.¹³^ORCID,Blaha Michael J.¹³^ORCID,Dzaye Omar¹³^ORCID

Affiliation:

1. Emory Clinical Cardiovascular Research Institute (A.C.R., A.A.Q., V.V., L.S.S.), Emory University School of Medicine, Atlanta, GA.

2. Translational Laboratory for Cardiothoracic Imaging and Artificial Intelligence (A.C.R., C.K., M.v.A., C.N.D.C.), Emory University School of Medicine, Atlanta, GA.

3. Department of Radiology, Korea University College of Medicine, Ansan Hospital (C.K.).

4. Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA (D.S.B.).

5. Lundquist Institute, Harbor-University of California Los Angeles Medical Center, Torrance, CA (M.J. Budoff).

6. Minneapolis Heart Institute and Foundation, MN (M.D.M.).

7. Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, TX (K.N.).

8. Division of Cardiology, Mount Sinai, St. Luke’s Hospital, New York, NY (A.R.).

9. Department of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA (C.F.).

10. Corazon Imaging, Columbus, OH (J.A.R.).

11. Department of Cardiology, Aarhus University Hospital, Denmark (M.B.M.).

12. Department of Radiology, Weill Cornell Medicine, New York, NY (L.J.S.).

13. Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (R.S.B., S.P.W., M.J. Blaha, O.D.).

Abstract

BACKGROUND: The development of thoracic aortic calcium (TAC) temporally precedes coronary artery calcium more often in women versus men. Whether TAC density and area confer sex-specific differences in atherosclerotic cardiovascular disease (ASCVD) risk is unknown. METHODS: We studied 5317 primary prevention patients who underwent coronary artery calcium scoring on noncontrast cardiac gated computed tomography with TAC >0. The Agatston TAC score (Agatston units), density (Hounsfield units), and area (mm 2 ) were compared between men and women. Cox proportional hazards regression calculated adjusted hazard ratios for TAC density-area groups with ASCVD mortality, adjusting for traditional risk factors, coronary artery calcium, and TAC. Multinomial logistic regression calculated adjusted odds ratios for the association between traditional risk factors and TAC density-area groups. RESULTS: The mean age was 60.7 years, 38% were women, and 163 ASCVD deaths occurred over a median of 11.7-year follow-up. Women had higher median TAC scores (97 versus 84 Agatston units; P =0.004), density (223 versus 210 Hounsfield units; P <0.001), and area (37 versus 32 mm 2 ; P =0.006) compared with men. There was a stepwise higher incidence of ASCVD deaths across increasing TAC density-area groups in men though women with low TAC density relative to TAC area (3.6 per 1000 person-years) had survival probability commensurate with the high-density-high-area group (4.8 per 1000 person-years). Compared with low TAC density-area, low TAC density/high TAC area conferred a 3.75-fold higher risk of ASCVD mortality in women (adjusted hazard ratio, 3.75 [95% CI, 1.13–12.44]) but not in men (adjusted hazard ratio, 1.16 [95% CI, 0.48–2.84]). Risk factors most strongly associated with low TAC density/high TAC area differed in women (diabetes: adjusted odds ratio, 2.61 [95% CI, 1.34–5.07]) versus men (hypertension: adjusted odds ratio, 1.45 [95% CI, 1.11–1.90]). CONCLUSIONS: TAC density-area phenotypes do not consistently associate with ASCVD mortality though low TAC density relative to area may be a marker of increased ASCVD risk in women.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine,Radiology, Nuclear Medicine and imaging

Reference15 articles.

1. Thoracic Aortic Calcification

2. Thoracic aortic calcification and coronary heart disease events: The multi-ethnic study of atherosclerosis (MESA)

3. Gender-Based Differences in the Prognostic Value of Coronary Calcification

4. Coronary Artery Calcium Score and Coronary Heart Disease Events in a Large Cohort of Asymptomatic Men and Women

5. Sex Differences in Coronary Artery and Thoracic Aorta Calcification and Their Association With Cardiovascular Mortality in Heavy Smokers