Elsevier

Atherosclerosis

Volume 214, Issue 2, February 2011, Pages 436-441
Atherosclerosis

Abdominal aortic calcium and multi-site atherosclerosis: The Multiethnic Study of Atherosclerosis

https://doi.org/10.1016/j.atherosclerosis.2010.09.011Get rights and content

Abstract

Background

Abdominal aortic calcification (AAC) is a measure of subclinical cardiovascular disease (CVD). Data are limited regarding its relation to other measures of atherosclerosis.

Methods

Among 1812 subjects (49% female, 21% black, 14% Chinese, and 25% Hispanic) within the population-based Multiethnic Study of Atherosclerosis, we examined the cross-sectional relation of AAC with coronary artery calcium (CAC), ankle brachial index (ABI), and carotid intimal medial thickness (CIMT), as well as multiple measures of subclinical CVD.

Results

AAC prevalence ranged from 34% in those aged 45–54 to 94% in those aged 75–84 (p < 0.0001), was highest in Caucasians (79%) and lowest in blacks (62%) (p < 0.0001). CAC prevalence, mean maximum CIMT  1 mm, and ABI < 0.9 was greater in those with vs. without AAC: CAC 60% vs. 16%, CIMT 38% vs. 7%, and ABI 5% vs. 1% for women and CAC 80% vs. 37%, CIMT 43% vs. 16%, and ABI 4% vs. 2% for men (p < 0.01 for all except p < 0.05 for ABI in men). The substantially greater prevalence for CAC in men compared to women all ages is not seen for AAC. By age 65, 97% of men and 91% of women have AAC, CAC, increased CIMT, and/or low ABI. The presence of multi-site atherosclerosis (≥3 of the above) ranged from 20% in women to 30% in men (p < 0.001), was highest in Caucasians (28%) and lowest in Chinese (16%) and ranged from 5% in those aged 45–54 to 53% in those aged 75–84 (p < 0.01 to p < 0.001). Finally, increased AAC was associated with 2–3-old relative risks for the presence of increased CIMT, low ABI, or CAC.

Conclusions

AAC is associated with an increased likelihood of other vascular atherosclerosis. Its additive prognostic value to these other measures is of further interest.

Section snippets

Study population

MESA is a prospective epidemiologic study of the prevalence, risk factors and progression of subclinical cardiovascular disease (CVD) [13]. Briefly, 6814 participants aged 45–84 free of clinical CVD, identified as White, African-American, Hispanic, or Chinese, were recruited from six U.S. communities (Forsyth County, NC, Northern Manhattan and the Bronx, NY, Baltimore City and Baltimore County, MD, St. Paul, MN, Chicago, IL, and Los Angeles County, CA) in 2000–2002. Participants were solicited

Results

Age, gender, cardiovascular risk factors and measures of subclinical atherosclerosis are presented overall and by ethnicity in Table 1. Approximately 21% of subjects were black, 25% Hispanic, and 14% Chinese and 49% of the sample was female. All major risk factors and measures of subclinical disease differed significantly (p < 0.001) across ethnicity. Blood pressure levels, current smoking, and HDL-cholesterol levels were highest in blacks. LDL-cholesterol, triglycerides, and diabetes prevalence

Discussion

AAC is strongly associated with subclinical CVD in other vascular beds, including the coronary, carotid, and leg arteries. While less than 20% of persons under age 65 have evidence of subclinical atherosclerosis in ≥3 vascular beds, this increases to more than 50% after age 75. While the presence of AAC was closely associated with the presence of subclinical CVD elsewhere, even in the absence of AAC, subclinical CVD elsewhere was present in over one-fourth of women and nearly half of men.

Acknowledgements

This research was supported by contracts N01-HC-95159 through N01-HC-95165, N01-HC-95169, and R01 HL-65580 from the National Heart, Lung, and Blood Institute. The authors thank the other investigators, staff, and participants of the MESA study for their valuable contributions. A full list of participating MESA investigators and institutions can be found at http://www.mesa-nhlbi.org.

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