This article is more than 5 years old. Information may no longer be current.
Unfavorable CV health despite no CAC elevates risk for calcium progression
Patients who did not have coronary artery calcium at baseline and few ideal CV health factors had an increased risk for CAC progression, according to a study published in Circulation: Cardiovascular Imaging.
Shih-Jen Hwang, PhD, MHS, staff scientist at the Intramural Research Program of the NHLBI, and colleagues analyzed data from 1,119 participants (mean age, 48 years; 58% women) from the Framingham Heart Study who had low baseline CVD risk and no CAC.
Six American Heart Association guideline metrics were used to characterize ideal CV health status. The metrics included BP, total cholesterol, fasting glucose, cigarette smoking, BMI and exercise. Information was collected through a physical examination and an interview. Participants were categorized based on the number of metrics. Those with favorable health (25%) had five or more metrics, intermediate health was defined as three or four metrics (51%) and unfavorable health was classified as those with two or fewer metrics (24%).
CAC was measured at baseline and follow-up, which was conducted for a mean of 6.1 years. Progression of CAC was defined as calcium that was newly detected with an Agatston score of greater than 3.4.
During follow-up, CAC progression was seen in 17.1% of participants.
Those with unfavorable CV health had an increased risk for CAC progression (OR = 2.43; 95% CI, 1.4-4.23) after adjusting for sex, age, triglycerides, HDL and familial correlation.
Each unit decrease in ideal CV health was linked to increased risk for CAC progression (OR = 1.15; 95% CI, 0.99-1.34) when adjusted for baseline ideal health metrics.
“Significant associations between an unfavorable CV [health] profile and CAC progression provide supportive evidence for public health measures to prevent CVD by promoting favorable CV [health] profiles in persons free of both clinical and subclinical CVD,” Hwang and colleagues wrote.
“Because CAC is presently the most informative subclinical measure of atherosclerosis, standardizing the measurement of CAC progression would help produce more reproducible results,” Joseph Yeboah, MD, MS, assistant professor of cardiology epidemiology and prevention at Wake Forest School of Medicine, wrote in a related editorial. “As we approach the year 2020, there should be no ambiguity about the use of the yardstick for monitoring progress toward the set goals. A problematic yardstick may take us to a different destination from what was anticipated.” – by Darlene Dobkowski
Disclosures: The authors and Yeboah report no relevant financial disclosures.