637 results on '"Miedema, Michael D."'
Search Results
2. Omega-3 fatty acids, subclinical atherosclerosis, and cardiovascular events: Implications for primary prevention
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Alfaddagh, Abdulhamied, Kapoor, Karan, Dardari, Zeina A, Bhatt, Deepak L, Budoff, Matthew J, Nasir, Khurram, Miller, Michael, Welty, Francine K, Miedema, Michael D, Shapiro, Michael D, Tsai, Michael Y, Blumenthal, Roger S, and Blaha, Michael J
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Biomedical and Clinical Sciences ,Nutrition and Dietetics ,Clinical Research ,Prevention ,Complementary and Integrative Health ,Heart Disease ,Heart Disease - Coronary Heart Disease ,Aging ,Nutrition ,Cardiovascular ,Atherosclerosis ,Stroke ,Aged ,Cardiovascular Diseases ,Coronary Artery Disease ,Disease Progression ,Docosahexaenoic Acids ,Eicosapentaenoic Acid ,Fatty Acids ,Omega-3 ,Female ,Humans ,Male ,Middle Aged ,Primary Prevention ,Risk Factors ,Eicosapentaenoic acid ,Docosahexaenoic acid ,Coronary artery calcium ,Cardiovascular disease ,Primary prevention ,Cardiorespiratory Medicine and Haematology ,Clinical Sciences ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Abstract
Background and aimsHigh-dose eicosapentaenoic acid (EPA) therapy was beneficial in high-risk patients without clinical cardiovascular disease (CVD). Whether higher plasma levels of EPA and docosahexaenoic acid (DHA) have similar benefits in those without subclinical CVD is unclear. We aim to evaluate the interplay between plasma omega-3 fatty acids and coronary artery calcium (CAC) in relation to CVD events.MethodsWe examined 6568 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) with plasma EPA and DHA levels and CAC measured at baseline. The primary outcome was incident CVD events (myocardial infarction, angina, cardiac arrest, stroke, CVD death). Hazard ratios for the primary outcome were adjusted for potential confounder using Cox regression.ResultsMean ± SD age was 62.1 ± 10.2 years and 52.9% were females. The median follow-up time was 15.6 years. Higher loge(EPA) (adjusted hazard ratio, aHR = 0.83; 95% CI, 0.74-0.94) and loge(DHA) (aHR = 0.79; 95% CI, 0.66-0.96) were independently associated with fewer CVD events. The difference in absolute CVD event rates between lowest vs. highest EPA tertile increased at higher CAC levels. The adjusted HR for highest vs. lowest EPA tertile within CAC = 0 was 1.02 (95% CI, 0.72-1.46), CAC = 1-99 was 0.71 (95% CI, 0.51-0.99), and CAC≥100 was 0.67 (95% CI, 0.52-0.84). A similar association was seen in tertiles of DHA by CAC category.ConclusionsIn an ethnically diverse population free of clinical CVD, higher plasma omega-3 fatty acid levels were associated with fewer long-term CVD events. The absolute decrease in CVD events with higher omega-3 fatty acid levels was more apparent at higher CAC scores.
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- 2022
3. Coronary Artery Calcium for Risk Stratification of Sudden Cardiac Death The Coronary Artery Calcium Consortium
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Razavi, Alexander C, Uddin, SM Iftekhar, Dardari, Zeina A, Berman, Daniel S, Budoff, Matthew J, Miedema, Michael D, Osei, Albert D, Obisesan, Olufunmilayo H, Nasir, Khurram, Rozanski, Alan, Rumberger, John A, Shaw, Leslee J, Sperling, Laurence S, Whelton, Seamus P, Mortensen, Martin Bødtker, Blaha, Michael J, and Dzaye, Omar
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Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Clinical Sciences ,Clinical Research ,Cardiovascular ,Heart Disease ,Patient Safety ,Atherosclerosis ,Prevention ,Heart Disease - Coronary Heart Disease ,Good Health and Well Being ,Calcium ,Coronary Artery Disease ,Death ,Sudden ,Cardiac ,Female ,Humans ,Male ,Middle Aged ,Predictive Value of Tests ,Risk Assessment ,Risk Factors ,Vascular Calcification ,cardiovascular diseases ,coronary artery calcium ,multidetector computed tomography ,sudden cardiac death ,Cardiorespiratory Medicine and Haematology ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Abstract
BackgroundCoronary artery calcium (CAC) is a marker of plaque burden. Whether CAC improves risk stratification for incident sudden cardiac death (SCD) beyond atherosclerotic cardiovascular disease (ASCVD) risk factors is unknown.ObjectivesSCD is a common initial manifestation of coronary heart disease (CHD); however, SCD risk prediction remains elusive.MethodsThe authors studied 66,636 primary prevention patients from the CAC Consortium. Multivariable competing risks regression and C-statistics were used to assess the association between CAC and SCD, adjusting for demographics and traditional risk factors.ResultsThe mean age was 54.4 years, 33% were women, 11% were of non-White ethnicity, and 55% had CAC >0. A total of 211 SCD events (0.3%) were observed during a median follow-up of 10.6 years, 91% occurring among those with baseline CAC >0. Compared with CAC = 0, there was a stepwise higher risk (P trend 1,000 (SHR: 4.9; 95% CI: 2.6-9.9). CAC provided incremental improvements in the C-statistic for the prediction of SCD among individuals with a 10-year risk 20% (ΔC-statistic = +0.01; P = 0.54).ConclusionsHigher CAC burden strongly associates with incident SCD beyond traditional risk factors, particularly among primary prevention patients with low-intermediate risk. SCD risk stratification can be useful in the early stages of CHD through the measurement of CAC, identifying patients most likely to benefit from further downstream testing.
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- 2022
4. Distribution of Coronary Artery Calcium by Age, Sex, and Race Among Patients 30-45 Years Old
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Javaid, Aamir, Dardari, Zeina A, Mitchell, Joshua D, Whelton, Seamus P, Dzaye, Omar, Lima, Joao AC, Lloyd-Jones, Donald M, Budoff, Matthew, Nasir, Khurram, Berman, Daniel S, Rumberger, John, Miedema, Michael D, Villines, Todd C, and Blaha, Michael J
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Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Heart Disease - Coronary Heart Disease ,Prevention ,Aging ,Heart Disease ,Cardiovascular ,Adult ,Atherosclerosis ,Calcium ,Cardiovascular Diseases ,Coronary Artery Disease ,Coronary Vessels ,Female ,Humans ,Male ,Middle Aged ,Risk Assessment ,Risk Factors ,Vascular Calcification ,Young Adult ,cardiovascular diseases ,cardiovascular risk ,coronary artery calcium ,coronary artery disease ,multidetector computed tomography ,percentiles ,premature atherosclerosis ,primary prevention ,young adults ,Cardiorespiratory Medicine and Haematology ,Public Health and Health Services ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology - Abstract
BackgroundCoronary artery calcium (CAC) is a measure of atherosclerotic burden and is well-validated for risk stratification in middle- to older-aged adults. Few studies have investigated CAC in younger adults, and there is no calculator for determining age-, sex-, and race-based percentiles among individuals aged 0 and develop age-sex-race percentiles for U.S. adults aged 30-45 years.MethodsWe harmonized 3 datasets-CARDIA (Coronary Artery Risk Development in Young Adults), the CAC Consortium, and the Walter Reed Cohort-to study CAC in 19,725 asymptomatic Black and White individuals aged 30-45 years without known atherosclerotic cardiovascular disease. After weighting each cohort equally, the probability of CAC >0 and age-sex-race percentiles of CAC distributions were estimated using nonparametric techniques.ResultsThe prevalence of CAC >0 was 26% among White males, 16% among Black males, 10% among White females, and 7% among Black females. CAC >0 automatically placed all females at >90th percentile. CAC >0 placed White males at the 90th percentile at age 34 years compared with Black males at age 37 years. An interactive webpage allows one to enter an age, sex, race, and CAC score to obtain the corresponding estimated percentile.ConclusionsIn a large cohort of U.S. adults aged 30-45 years without symptomatic atherosclerotic cardiovascular disease, the probability of CAC >0 varied by age, sex, and race. Estimated percentiles may help interpretation of CAC scores among young adults relative to their age-sex-race matched peers and can henceforth be included in CAC score reporting.
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- 2022
5. Left Main Coronary Artery Calcium and Diabetes Confer Very-High-Risk Equivalence in Coronary Artery Calcium >1,000
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Razavi, Alexander C., Shaw, Leslee J., Berman, Daniel S., Budoff, Matthew J., Wong, Nathan D., Vaccarino, Viola, van Assen, Marly, De Cecco, Carlo N., Quyyumi, Arshed A., Mehta, Anurag, Muntner, Paul, Miedema, Michael D., Rozanski, Alan, Rumberger, John A., Nasir, Khurram, Blumenthal, Roger S., Sperling, Laurence S., Mortensen, Martin Bødtker, Whelton, Seamus P., Blaha, Michael J., and Dzaye, Omar
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- 2024
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6. Mean Versus Peak Coronary Calcium Density on Non-Contrast CT Calcium Scoring and ASCVD Risk Prediction
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Dzaye, Omar, Razavi, Alexander C, Dardari, Zeina A, Berman, Daniel S, Budoff, Matthew J, Miedema, Michael D, Obisesan, Olufunmilayo H, Boakye, Ellen, Nasir, Khurram, Rozanski, Alan, Rumberger, John A, Shaw, Leslee J, Mortensen, Martin Bødtker, Whelton, Seamus P, and Blaha, Michael J
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Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Clinical Sciences ,Heart Disease - Coronary Heart Disease ,Prevention ,Atherosclerosis ,Heart Disease ,Cardiovascular ,Good Health and Well Being ,Adult ,Calcium ,Coronary Disease ,Female ,Humans ,Male ,Plaque ,Atherosclerotic ,Predictive Value of Tests ,Tomography ,X-Ray Computed ,Vascular Calcification ,Young Adult ,atherosclerotic plaque ,calcium density ,cardiovascular disease ,coronary artery calcium ,multidetector computed tomography ,primary prevention ,risk ,vascular calcification ,Cardiorespiratory Medicine and Haematology ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Abstract
ObjectivesThis study sought to assess the relationship between mean vs peak calcified plaque density and their impact on calculating coronary artery calcium (CAC) scores and to compare the corresponding differential prediction of atherosclerotic cardiovascular disease (ASCVD) and coronary heart disease (CHD) mortality.BackgroundThe Agatston CAC score is quantified per lesion as the product of plaque area and a 4-level categorical peak calcium density factor. However, mean calcium density may more accurately measure the heterogenous mixture of lipid-rich, fibrous, and calcified plaque reflective of ASCVD risk.MethodsWe included 10,373 individuals from the CAC Consortium who had CAC >0 and per-vessel measurements of peak calcium density factor and mean calcium density. Area under the curve and continuous net reclassification improvement analyses were performed for CHD and ASCVD mortality to compare the predictive abilities of mean calcium density vs peak calcium density factor when calculating the Agatston CAC score.ResultsParticipants were on average 53.4 years of age, 24.4% were women, and the median CAC score was 68 Agatston units. The average values for mean calcium density and peak calcium density factor were 210 ± 50 HU and 3.1 ± 0.5, respectively. Individuals younger than 50 years of age and/or those with a total plaque area 100.ConclusionMean and peak calcium density may differentially describe plaque composition early in the atherosclerotic process. Mean calcium density performs better than peak calcium density factor when combined with plaque area for ASCVD mortality prediction among persons with Agatston CAC 1-99.
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- 2022
7. Thoracic Aortic Calcium Density and Area in Long-Term Atherosclerotic Cardiovascular Disease Risk Among Men Versus Women
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Razavi, Alexander C., Kim, Cherry, van Assen, Marly, De Cecco, Carlo N., Berman, Daniel S., Budoff, Matthew J., Quyyumi, Arshed A., Vaccarino, Viola, Miedema, Michael D., Nasir, Khurram, Rozanski, Alan, Fernandez, Camilo, Rumberger, John A., Shaw, Leslee J., Bødtker Mortensen, Martin, Wong, Nathan D., Blumenthal, Roger S., Sperling, Laurence S., Whelton, Seamus P., Blaha, Michael J., and Dzaye, Omar
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- 2023
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8. Determinants of Incident Atherosclerotic Cardiovascular Disease Events Among Those With Absent Coronary Artery Calcium: Multi-Ethnic Study of Atherosclerosis
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Al Rifai, Mahmoud, Blaha, Michael J, Nambi, Vijay, Shea, Steven JC, Michos, Erin D, Blumenthal, Roger S, Ballantyne, Christie M, Szklo, Moyses, Greenland, Philip, Miedema, Michael D, Nasir, Khurram, Rotter, Jerome I, Guo, Xiuqing, Yao, Jie, Post, Wendy S, and Virani, Salim S
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Epidemiology ,Health Sciences ,Heart Disease ,Tobacco Smoke and Health ,Atherosclerosis ,Tobacco ,Aging ,Cardiovascular ,Prevention ,Diabetes ,Clinical Research ,Heart Disease - Coronary Heart Disease ,Evaluation of treatments and therapeutic interventions ,6.1 Pharmaceuticals ,Stroke ,Good Health and Well Being ,Calcium ,Cardiovascular Diseases ,Coronary Vessels ,Ethnicity ,Female ,Humans ,Male ,Middle Aged ,Risk Factors ,United States ,carotid artery diseases ,coronary artery disease ,heart disease risk factors ,Cardiorespiratory Medicine and Haematology ,Clinical Sciences ,Public Health and Health Services ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences ,Sports science and exercise - Abstract
BackgroundThe 2018 American Heart Association/American College of Cardiology/Multisociety cholesterol guideline states that statin therapy may be withheld or delayed among intermediate-risk individuals in the absence of coronary artery calcium (CAC=0). We evaluated whether traditional cardiovascular risk factors are associated with incident atherosclerotic cardiovascular disease (ASCVD) events among individuals with CAC=0 over long-term follow-up.MethodsWe included participants with CAC=0 at baseline from the MESA (Multi-Ethnic Study of Atherosclerosis), a prospective cohort study of individuals free of clinical ASCVD at baseline. We used multivariable-adjusted Cox proportional hazards models to study the association between cardiovascular risk factors (cigarette smoking, diabetes, hypertension, preventive medication use [aspirin and statin], family history of premature ASCVD, chronic kidney disease, waist circumference, lipid and inflammatory markers) and adjudicated incident ASCVD outcomes.ResultsWe studied 3416 individuals (mean [SD] age 58 [9] years; 63% were female, 33% White, 31% Black, 12% Chinese American, and 24% Hispanic). Over a median follow-up of 16 years, there were 189 ASCVD events (composite of coronary heart disease and stroke) of which 91 were coronary heart disease, 88 were stroke, and 10 were both coronary heart disease and stroke events. The unadjusted event rates of ASCVD were ≤5 per 1000 person-years among individuals with CAC=0 for most risk factors with the exception of current cigarette smoking (7.3), diabetes (8.9), hypertension (5.4), and chronic kidney disease (6.8). After multivariable adjustment, risk factors that were significantly associated with ASCVD included current cigarette smoking: hazard ratio, 2.12 (95% CI, 1.32-3.42); diabetes: hazard ratio, 1.68 (95% CI, 1.01-2.80); and hypertension: hazard ratio, 1.57 (95% CI, 1.06-2.33).ConclusionsCurrent cigarette smoking, diabetes, and hypertension are independently associated with incident ASCVD over a 16-year follow-up among those with CAC=0.
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- 2022
9. Coronary artery calcium is associated with long-term mortality from lung cancer: Results from the Coronary Artery Calcium Consortium
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Dzaye, Omar, Berning, Philipp, Dardari, Zeina A, Berman, Daniel S, Budoff, Matthew J, Miedema, Michael D, Nasir, Khurram, Rozanski, Alan, Rumberger, John A, Shaw, Leslee J, Mortensen, Martin Bødtker, Whelton, Seamus P, and Blaha, Michael J
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Biomedical and Clinical Sciences ,Oncology and Carcinogenesis ,Prevention ,Lung ,Heart Disease ,Aging ,Cardiovascular ,Clinical Research ,Lung Cancer ,Cancer ,Heart Disease - Coronary Heart Disease ,Detection ,screening and diagnosis ,4.1 Discovery and preclinical testing of markers and technologies ,Good Health and Well Being ,Aged ,Calcium ,Cause of Death ,Coronary Artery Disease ,Coronary Vessels ,Early Detection of Cancer ,Female ,Humans ,Lung Neoplasms ,Male ,Middle Aged ,Risk Assessment ,Risk Factors ,Vascular Calcification ,Coronary arterial calcium ,Lung cancer ,Cardiovascular disease ,Risk prediction ,Cardiorespiratory Medicine and Haematology ,Clinical Sciences ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Abstract
Background and aimsCoronary artery calcium (CAC) scores have been shown to be associated with CVD and cancer mortality. The use of CAC scores for overall and lung cancer mortality risk prediction for patients in the Coronary Artery Calcium Consortium was analyzed.MethodsWe included 55,943 patients aged 44-84 years without known heart disease from the CAC Consortium. There were 1,088 cancer deaths, among which 231 were lung cancer, identified by death certificates with a mean follow-up of 12.2 ± 3.9 years. Fine-and-Gray competing-risk regression was used for overall and lung cancer-specific mortality, accounting for the competing risk of CVD death and after adjustment for CVD risk factors. Subdistribution hazard ratios (SHR) were reported.ResultsThe mean age of all patients was 57.1 ± 8.6 years, 34.9% were women, and 89.6% were white. Overall, CAC was strongly associated with cancer mortality. Lung cancer mortality increased with increasing CAC scores, with rates per 1000-person years of 0.2 (95% CI: 0.1-0.3) for CAC = 0 and 0.8 (95% CI: 0.6-1.0) for CAC ≥400. Compared with CAC = 0, hazards were increased for those with CAC ≥400 for lung cancer mortality [SHR: 1.7 (95% CI: 1.2-2.6)], which was driven by women [SHR: 2.3 (95% CI: 1.1-4.8)], but not significantly increased for men. Risks were higher in those with positive smoking history [SHR: 2.2 (95% CI: 1.2-4.2)], with associations driven by women [SHR: 4.0 (95% CI: 1.4-11.5)].ConclusionsCAC scores were associated with increased risks for lung cancer mortality, with strongest associations for current and former smokers, especially in women. Used in conjunction with other clinical variables, our data pinpoint a potential synergistic use of CAC scanning beyond CVD risk assessment for identification of high-risk lung cancer screening candidates.
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- 2021
10. Implication of thoracic aortic calcification over coronary calcium score regarding the 2018 ACC/AHA Multisociety cholesterol guideline: results from the CAC Consortium
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Han, Donghee, Kuronuma, Keiichiro, Rozanski, Alan, Budoff, Matthew J, Miedema, Michael D, Nasir, Khurram, Shaw, Leslee J, Rumberger, John A, Gransar, Heidi, Blumenthal, Roger S, Blaha, Michael J, and Berman, Daniel S
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Biomedical and Clinical Sciences ,Clinical Sciences ,Prevention ,Atherosclerosis ,Cardiovascular ,Heart Disease - Coronary Heart Disease ,Clinical Research ,Heart Disease ,Good Health and Well Being ,Thoracic aortic calcification ,Coronary artery calcium ,Prognosis ,Cardiovascular mortality ,Computed tomography ,Cardiovascular medicine and haematology - Abstract
ObjectiveTAC is associated with an increased atherosclerotic cardiovascular disease (ASCVD) risk, but it is unclear how to interpret thoracic aortic calcification (TAC) findings in conjunction with ASCVD risk and coronary artery calcium (CAC) score according to 2018 ACC/AHA Multisociety cholesterol guidelines. We evaluate the incremental value of thoracic aortic calcification TAC over CAC for predicting and reclassifying ASCVD mortality risk.MethodThe study included 30,630 asymptomatic individuals (mean age: 55 ± 8 years, male: 64%) from the CAC Consortium. TAC was categorized as TAC 0, 1-300, and >300. Patients were categorized as low (100 (initiate stain).ResultsDuring the median 11.2 years (IQR 9.2-12.4) follow-up, 345 (1.1%) CVD deaths occurred. TAC>300 was associated with increased CVD mortality after adjusting for ASCVD risk and CAC (HR:4.72, 95% CI: 3.39-6.57, p300 was associated with an increased CVD mortality risk across each statin eligibility group (all p
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- 2021
11. Prognostic significance of aortic valve calcium in relation to coronary artery calcification for long-term, cause-specific mortality: results from the CAC Consortium
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Han, Donghee, Cordoso, Rhanderson, Whelton, Seamus, Rozanski, Alan, Budoff, Matthew J, Miedema, Michael D, Nasir, Khurram, Shaw, Leslee J, Rumberger, John A, Gransar, Heidi, Dardari, Zeina, Blumenthal, Roger S, Blaha, Michael J, and Berman, Daniel S
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Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Clinical Sciences ,Heart Disease - Coronary Heart Disease ,Cardiovascular ,Prevention ,Heart Disease ,Aging ,Atherosclerosis ,4.2 Evaluation of markers and technologies ,Detection ,screening and diagnosis ,Aetiology ,2.4 Surveillance and distribution ,Good Health and Well Being ,Aortic Valve ,Calcium ,Cause of Death ,Coronary Artery Disease ,Female ,Humans ,Male ,Middle Aged ,Prognosis ,Risk Assessment ,Risk Factors ,Vascular Calcification ,aortic valve sclerosis ,cardiovascular mortality ,coronary artery calcium ,computed tomography ,prognosis ,Cardiovascular medicine and haematology - Abstract
AimsAortic valve calcification (AVC) has been shown to be associated with increased cardiovascular disease (CVD) risk; however, whether this is independent of traditional risk factors and coronary artery calcification (CAC) remains unclear.Methods and resultsFrom the multicentre CAC Consortium database, 10 007 patients (mean 55.8±11.7 years, 64% male) with concomitant CAC and AVC scoring were included in the current analysis. AVC score was quantified using the Agatston score method and categorized as 0, 1-99, and ≥100. The endpoints were all-cause, CVD, and coronary heart disease (CHD) deaths. AVC (AVC>0) was observed in 1397 (14%) patients. During a median 7.8 (interquartile range: 4.7-10.6) years of study follow-up, 511 (5.1%) deaths occurred; 179 (35%) were CVD deaths, and 101 (19.8%) were CHD deaths. A significant interaction between CAC and AVC for mortality was observed (P
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- 2021
12. Modeling the Recommended Age for Initiating Coronary Artery Calcium Testing Among At-Risk Young Adults
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Dzaye, Omar, Razavi, Alexander C, Dardari, Zeina A, Shaw, Leslee J, Berman, Daniel S, Budoff, Matthew J, Miedema, Michael D, Nasir, Khurram, Rozanski, Alan, Rumberger, John A, Orringer, Carl E, Smith, Sidney C, Blankstein, Ron, Whelton, Seamus P, Mortensen, Martin Bødtker, and Blaha, Michael J
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Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Cardiovascular ,Atherosclerosis ,Heart Disease ,Prevention ,Aging ,Heart Disease - Coronary Heart Disease ,Clinical Research ,Good Health and Well Being ,Adult ,Cohort Studies ,Computed Tomography Angiography ,Coronary Artery Disease ,Disease Susceptibility ,Female ,Humans ,Male ,Middle Aged ,Models ,Cardiovascular ,Retrospective Studies ,Risk Assessment ,Risk Factors ,Vascular Calcification ,  ,cardiovascular diseases ,coronary artery calcium ,multidetector computed tomography ,premature atherosclerosis ,young adults ,Cardiorespiratory Medicine and Haematology ,Public Health and Health Services ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology - Abstract
BackgroundThere are currently no recommendations guiding when best to perform coronary artery calcium (CAC) scanning among young adults to identify those susceptible for developing premature atherosclerosis.ObjectivesThe purpose of this study was to determine the ideal age at which a first CAC scan has the highest utility according to atherosclerotic cardiovascular disease (ASCVD) risk factor profile.MethodsWe included 22,346 CAC Consortium participants aged 30-50 years who underwent noncontrast computed tomography. Sex-specific equations were derived from multivariable logistic modeling to estimate the expected probability of CAC >0 according to age and the presence of ASCVD risk factors.ResultsParticipants were on average 43.5 years of age, 25% were women, and 34% had CAC >0, in whom the median CAC score was 20. Compared with individuals without risk factors, those with diabetes developed CAC 6.4 years earlier on average, whereas smoking, hypertension, dyslipidemia, and a family history of coronary heart disease were individually associated with developing CAC 3.3-4.3 years earlier. Using a testing yield of 25% for detecting CAC >0, the optimal age for a potential first scan would be at 36.8 years (95% CI: 35.5-38.4 years) in men and 50.3 years (95% CI: 48.7-52.1 years) in women with diabetes, and 42.3 years (95% CI: 41.0-43.9 years) in men and 57.6 years (95% CI: 56.0-59.5 years) in women without risk factors.ConclusionsOur derived risk equations among health-seeking young adults enriched in ASCVD risk factors inform the expected prevalence of CAC >0 and can be used to determine an appropriate age to initiate clinical CAC testing to identify individuals most susceptible for early/premature atherosclerosis.
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- 2021
13. Abstract 18737: Coronary Artery Calcium for Allocation of Aspirin in Light of the 2022 USPSTF Guideline Recommendations: Results From the Multi-Ethnic Study of Atherosclerosis (MESA)
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Verghese, Dhiran, Boakye, Ellen, Blaha, Michael J, Manubolu, Sanjay, Aldana, Jairo, Kinninger, April, Dardari, Zeina A, Cubeddu, Robert, Albaghdadi, Mazen, Miedema, Michael D, Yeboah, Joseph, Roy, Sion, Cainzos, Miguel, and Budoff, Matthew J
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- 2023
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14. Machine Learning Adds to Clinical and CAC Assessments in Predicting 10-Year CHD and CVD Deaths
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Nakanishi, Rine, Slomka, Piotr J, Rios, Richard, Betancur, Julian, Blaha, Michael J, Nasir, Khurram, Miedema, Michael D, Rumberger, John A, Gransar, Heidi, Shaw, Leslee J, Rozanski, Alan, Budoff, Matthew J, and Berman, Daniel S
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Biomedical and Clinical Sciences ,Clinical Sciences ,Cardiovascular ,Prevention ,Heart Disease - Coronary Heart Disease ,Atherosclerosis ,Heart Disease ,Detection ,screening and diagnosis ,4.2 Evaluation of markers and technologies ,Good Health and Well Being ,Adult ,Aged ,Cardiovascular Diseases ,Coronary Artery Disease ,Female ,Humans ,Machine Learning ,Male ,Middle Aged ,Predictive Value of Tests ,cardiovascular disease death ,coronary artery calcification ,coronary heart disease death ,machine learning ,pooled cohort equation ,Cardiorespiratory Medicine and Haematology ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Abstract
ObjectivesThe aim of this study was to evaluate whether machine learning (ML) of noncontrast computed tomographic (CT) and clinical variables improves the prediction of atherosclerotic cardiovascular disease (ASCVD) and coronary heart disease (CHD) deaths compared with coronary artery calcium (CAC) Agatston scoring and clinical data.BackgroundThe CAC score provides a measure of the global burden of coronary atherosclerosis, and its long-term prognostic utility has been consistently shown to have incremental value over clinical risk assessment. However, current approaches fail to integrate all available CT and clinical variables for comprehensive risk assessment.MethodsThe study included data from 66,636 asymptomatic subjects (mean age 54 ± 11 years, 67% men) without established ASCVD undergoing CAC scanning and followed for cardiovascular disease (CVD) and CHD deaths at 10 years. Clinical risk assessment incorporated the ASCVD risk score. For ML, an ensemble boosting approach was used to fit a predictive classifier for outcomes, followed by automated feature selection using information gain ratio. The model-building process incorporated all available clinical and CT data, including the CAC score; the number, volume, and density of CAC plaques; and extracoronary scores; comprising a total of 77 variables. The overall proposed model (ML all) was evaluated using a 10-fold cross-validation framework on the population data and area under the curve (AUC) as metrics. The prediction performance was also compared with 2 traditional scores (ASCVD risk and CAC score) and 2 additional models that were trained using all the clinical data (ML clinical) and CT variables (ML CT).ResultsThe AUC by ML all (0.845) for predicting CVD death was superior compared with those obtained by ASCVD risk alone (0.821), CAC score alone (0.781), and ML CT alone (0.804) (p
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- 2021
15. Comparing Risk Scores in the Prediction of Coronary and Cardiovascular Deaths Coronary Artery Calcium Consortium
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Blaha, Michael J, Whelton, Seamus P, Al Rifai, Mahmoud, Dardari, Zeina, Shaw, Leslee J, Al-Mallah, Mouaz H, Matsushita, Kunihiro, Rozanski, Alan, Rumberger, John A, Berman, Daniel S, Budoff, Matthew J, Miedema, Michael D, Nasir, Khurram, and Cainzos-Achirica, Miguel
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Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Clinical Sciences ,Atherosclerosis ,Heart Disease ,Aging ,Clinical Research ,Cardiovascular ,Prevention ,Heart Disease - Coronary Heart Disease ,4.2 Evaluation of markers and technologies ,Detection ,screening and diagnosis ,Good Health and Well Being ,Aged ,Calcium ,Coronary Artery Disease ,Coronary Vessels ,Female ,Humans ,Male ,Middle Aged ,Predictive Value of Tests ,Retrospective Studies ,Risk Assessment ,Risk Factors ,Vascular Calcification ,cardiovascular disease ,coronary artery calcium ,mortality ,risk ,score ,Cardiorespiratory Medicine and Haematology ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Abstract
ObjectivesThis study compared risk discrimination for the prediction of coronary heart disease (CHD) and cardiovascular disease (CVD) deaths for the Pooled Cohort Equations (PCE), the MESA (Multi-Ethnic Study of Atherosclerosis) Risk Score (with and without coronary artery calcium [CAC]), and of simple addition of CAC to the PCE.BackgroundThe PCE predict 10-year risk of atherosclerotic CVD events, and the MESA Risk Score predicts risk of CHD. Their comparative performance for the prediction of fatal events is poorly understood.MethodsWe evaluated 53,487 patients ages 45 to 79 years from the CAC Consortium, a retrospective cohort study of asymptomatic individuals referred for clinical CAC scoring. Risk discrimination was measured using C-statistics.ResultsMean age was 57 years, 35% were women, and 39% had CAC of 0. There were 421 CHD and 775 CVD deaths over a mean 12-year follow-up. In the overall study population, discrimination with the MESA Risk Score with CAC and the PCE was almost identical for both outcomes (C-statistics: 0.80 and 0.79 for CHD death, 0.77 and 0.78 for CVD death, respectively). Addition of CAC to the PCE improved risk discrimination, yielding the largest C-statistics. The MESA Risk Score with CAC and the PCE plus CAC showed the best discrimination among the 45% of patients with 5% to 20% estimated risk. Secondary analyses by estimated CVD risk strata showed modestly improved risk discrimination with CAC also among low- and high-estimated risk groups.ConclusionsOur findings support the current guideline recommendation to use, among available risk scores, the PCE for initial risk assessment and to use CAC for further risk assessment in a broad borderline and intermediate risk group. Also, in select individuals at low or high estimated risk, CAC modestly improved discrimination. Studies in unselected populations will lead to further understanding of the potential value of tools combining risk scores and CAC for optimal risk assessment.
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- 2021
16. Prognostic value of coronary artery calcium score, area, and density among individuals on statin therapy vs. non-users: The coronary artery calcium consortium
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Osei, Albert D, Mirbolouk, Mohammadhassan, Berman, Daniel, Budoff, Matthew J, Miedema, Michael D, Rozanski, Alan, Rumberger, John A, Shaw, Leslee, Al Rifai, Mahmoud, Dzaye, Omar, Graham, Garth N, Banach, Maciej, Blumenthal, Roger S, Dardari, Zeina A, Nasir, Khurram, and Blaha, Michael J
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Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Clinical Sciences ,Heart Disease ,Heart Disease - Coronary Heart Disease ,Prevention ,Cardiovascular ,4.2 Evaluation of markers and technologies ,Detection ,screening and diagnosis ,Good Health and Well Being ,Adult ,Calcium ,Coronary Artery Disease ,Coronary Vessels ,Female ,Humans ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,Male ,Middle Aged ,Prognosis ,Risk Assessment ,Risk Factors ,Vascular Calcification ,Coronary artery calcium ,Statins ,CAC area ,CAC volume ,CAC density ,Cardiorespiratory Medicine and Haematology ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Abstract
Background and aimsStatins do not decrease coronary artery calcium (CAC) and may increase existing calcification or its density. Therefore, we examined the prognostic significance of CAC among statin users at the time of CAC scanning.MethodsWe included 28,025 patients (6151 statin-users) aged 40-75 years from the CAC Consortium. Cox regression models were used to assess the association of CAC with coronary heart disease (CHD) and cardiovascular disease (CVD) mortality. Models were adjusted for traditional CVD risk factors. Additionally, we examined the predictive performance of CAC components including CAC area, volume, and density using an age- and sex-adjusted Cox regression model.ResultsParticipants (mean age 53.9 ± 10.3 years, 65.0% male) were followed for median 11.2 years. There were 395 CVD and 182 CHD deaths. One unit increase in log CAC score was associated with increased risk of CVD mortality (hazard ratio (HR), 1.2; 95% CI = 1.1-1.3) and CHD mortality (HR, 1.2; 95% CI = 1.1-1.4)) among statin users. There was a small but significant negative interaction between CAC score and statin use for the prediction of CHD (p-value = 0.036) and CVD mortality (p-value = 0.025). The volume score and CAC area were similarly associated with outcomes in statin users and non-users. Density was associated with CVD and CHD mortality in statin naïve patients, but with neither in statin users.ConclusionCAC scoring retains robust risk prediction in statin users, and the changing relationship of CAC density with outcomes may explain the slightly weaker relationship of CAC with outcomes in statin users.
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- 2021
17. Association between coronary artery calcium and cardiovascular disease as a supporting cause in cancer: The CAC consortium
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Wang, Frances M, Reiter–Brennan, Cara, Dardari, Zeina, Marshall, Catherine H, Nasir, Khurram, Miedema, Michael D, Berman, Daniel S, Rozanski, Alan, Rumberger, John A, Budoff, Matthew J, Dzaye, Omar, and Blaha, Michael J
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Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Prevention ,Cancer ,Heart Disease ,Cardiovascular ,Atherosclerosis ,Good Health and Well Being ,Biomarker ,Cardiac imaging ,Coronary artery calcium ,Cardiovascular medicine and haematology - Abstract
BackgroundIdentifying cancer patients at high risk of CVD is important for targeting CVD prevention strategies and evaluating chemotherapy options in the context of cardiotoxicity. Coronary artery calcium (CAC), a strong marker of coronary atherosclerosis, is used clinically to enhance risk assessment, yet the value of CAC for assessing risk of CVD complications in cancer is poorly understood.ObjectiveIn cases of cancer mortality, to determine the value of CAC for predicting risk of CVD as a supporting cause of death.MethodsThe CAC Consortium is a multi-center cohort of 66,636 asymptomatic adults without CVD who underwent CAC scanning. During a follow-up of 12.5 years, 1129 patients died of cancer and were included in this analysis. The primary outcome was presence of CVD listed as a supporting cause of cancer mortality on official death certificates obtained from the National Death Index. Logistic regression models were used to assess the odds of CVD being listed as a supporting cause of death by CAC.ResultsCVD was listed as a supporting cause of death in 306 (27%) cancer mortality cases. Baseline CAC was significantly higher in individuals with CVD-supported mortality. Odds ratios of having CVD-supported death increased by ASCVD risk score category [1.15 (0.81, 1.65) for 5-20% 10-year risk and 1.97 (1.36, 2.89) for ≥20% risk, in reference to
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- 2020
18. Association of triglyceride levels with adverse cardiovascular events in patients with ST-segment elevation myocardial infarction
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Yildiz, Mehmet, Miedema, Michael D., Murthy, Avinash, Henry, Timothy D., Bergstedt, Seth, Okeson, Brynn K., Schmidt, Christian W., Volpenhein, Lucas, Garcia, Santiago, Sharkey, Scott W., and Aguirre, Frank V.
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- 2023
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19. Coronary Artery Calcium and the Age-Specific Competing Risk of Cardiovascular Versus Cancer Mortality: The Coronary Artery Calcium Consortium
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Whelton, Seamus P, Rifai, Mahmoud Al, Marshall, Catherine Handy, Dardari, Zeina, Shaw, Leslee J, Al-Mallah, Mouaz H, Rozanski, Alan, Mortensen, Martin B, Dzaye, Omar, Bazzano, Lydia, Kelly, Tanika N, Matsushita, Kunihiro, Rumberger, John A, Berman, Daniel S, Budoff, Matthew J, Miedema, Michael D, Nasir, Khurram, and Blaha, Michael J
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Biomedical and Clinical Sciences ,Epidemiology ,Public Health ,Health Sciences ,Clinical Sciences ,Cardiovascular ,Cancer ,Prevention ,Heart Disease - Coronary Heart Disease ,Aging ,Heart Disease ,Detection ,screening and diagnosis ,4.1 Discovery and preclinical testing of markers and technologies ,Good Health and Well Being ,Adult ,Aged ,Cardiac-Gated Imaging Techniques ,Cardiovascular Diseases ,Cause of Death ,Coronary Artery Disease ,Female ,Humans ,Male ,Middle Aged ,Neoplasms ,Risk Assessment ,Severity of Illness Index ,Tomography ,X-Ray Computed ,Vascular Calcification ,Age ,Competing risk ,Coranary artery calcium ,Risk prediction ,Coronary artery calcium ,Medical and Health Sciences ,General & Internal Medicine ,Biomedical and clinical sciences ,Health sciences - Abstract
BackgroundCoronary artery calcium (CAC) is a guideline recommended cardiovascular disease (CVD) risk stratification tool that increases with age and is associated with non-cardiovascular disease outcomes including cancer. We sought to define the age-specific change in the association between CAC and cause-specific mortality.MethodsThe Coronary Artery Calcium Consortium includes 59,502 asymptomatic patients age 40-75 without known CVD. Age-stratified mortality rates and parametric survival regression modeling was performed to estimate the age-specific CAC score at which CVD and cancer mortality risk were equal.ResultsThe mean age was 54±8 years (67% men) and there were 2,423 deaths over a mean 12±3 years follow-up. Among individuals with CAC = 0, cancer was the leading cause of death, with low CVD mortality rates for both younger (40-54 years) 0.2/1,000 person-years and older participants (65-75 years) 1.3/1,000 person-years. When CAC ≥400, CVD was consistently the leading cause of death among younger (71% of deaths) and older participants (56% of deaths). The CAC score at which CVD overtook cancer as the leading cause of death increased exponentially with age and was approximately 115 at age 50 and 380 at age 65.ConclusionsRegardless of age, when CAC = 0 cancer was the leading cause of death and the cardiovascular disease mortality rate was low. Our age-specific estimate for the CAC score at which CVD overtakes cancer mortality allows for a more precise approach to synergistic prediction and prevention strategies for CVD and cancer.
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- 2020
20. Sex Differences in Coronary Artery Calcium and Mortality From Coronary Heart Disease, Cardiovascular Disease, and All Causes in Adults With Diabetes: The Coronary Calcium Consortium
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Wong, Nathan D, Hsu, Amber R Cordola, Rozanski, Alan, Shaw, Leslee J, Whelton, Seamus P, Budoff, Matthew J, Nasir, Khurram, Miedema, Michael D, Rumberger, John, Blaha, Michael J, and Berman, Daniel S
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Epidemiology ,Biomedical and Clinical Sciences ,Public Health ,Health Sciences ,Aging ,Cardiovascular ,Diabetes ,Heart Disease - Coronary Heart Disease ,Prevention ,Heart Disease ,Good Health and Well Being ,Adult ,Aged ,Aged ,80 and over ,Calcium ,Cardiovascular Diseases ,Cause of Death ,Coronary Artery Disease ,Diabetes Mellitus ,Diabetic Angiopathies ,Female ,Humans ,Male ,Middle Aged ,Mortality ,Risk Assessment ,Risk Factors ,Severity of Illness Index ,Sex Characteristics ,Time Factors ,United States ,Vascular Calcification ,Young Adult ,Medical and Health Sciences ,Endocrinology & Metabolism ,Biomedical and clinical sciences ,Health sciences - Abstract
ObjectiveWhile diabetes has been previously noted to be a stronger risk factor for cardiovascular disease (CVD) in women compared with men, whether this is still the case is not clear. Coronary artery calcium (CAC) predicts coronary heart disease (CHD) and CVD in people with diabetes; however, its sex-specific impact is less defined. We compared the relation of CAC in women versus men with diabetes for total, CVD, and CHD mortality.Research design and methodsWe studied adults with diabetes from a large registry of patients with CAC scanning with mortality follow-up over 11.5 years. Cox regression examined the relation of CAC with mortality end points.ResultsAmong 4,503 adults with diabetes (32.5% women) aged 21-93 years, 61.2% of women and 80.4% of men had CAC >0. Total, CVD, and CHD mortality rates were directly related to CAC; women had higher total and CVD death rates than men when CAC >100. Age- and risk factor-adjusted hazard ratios (HRs) per log unit CAC were higher among women versus men for total mortality (1.28 vs. 1.18) (interaction P = 0.01) and CVD mortality (1.47 vs. 1.27) (interaction P = 0.04) but were similar for CHD mortality (1.48 and 1.48). For CVD mortality, HRs with CAC scores of 101-400 and >400 were 3.67 and 6.27, respectively, for women and 1.63 and 3.48, respectively, for men (interaction P = 0.04). For total mortality, HRs were 2.56 and 4.05 for women, respectively, and 1.88 and 2.66 for men, respectively (interaction P = 0.01).ConclusionsCAC predicts CHD, CVD, and all-cause mortality in patients with diabetes; however, greater CAC predicts CVD and total mortality more strongly in women.
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- 2020
21. Estimated versus observed 10-year atherosclerotic cardiovascular event rates in a rural population-based health initiative: The Heart of New Ulm Project
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Van Hove, Christopher, Haq, Ayman, Phillips, Angela, Sidebottom, Abbey, Vacquier, Marc, Benson, Gretchen, Knickelbine, Thomas, and Miedema, Michael D
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- 2023
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22. Coronary Artery Calcium for Personalized Allocation of Aspirin in Primary Prevention of Cardiovascular Disease in 2019
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Cainzos-Achirica, Miguel, Miedema, Michael D, McEvoy, John W, Al Rifai, Mahmoud, Greenland, Philip, Dardari, Zeina, Budoff, Matthew, Blumenthal, Roger S, Yeboah, Joseph, Duprez, Daniel A, Mortensen, Martin Bødtker, Dzaye, Omar, Hong, Jonathan, Nasir, Khurram, and Blaha, Michael J
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Epidemiology ,Biomedical and Clinical Sciences ,Public Health ,Health Sciences ,Patient Safety ,Prevention ,Heart Disease ,Heart Disease - Coronary Heart Disease ,Atherosclerosis ,Cardiovascular ,Clinical Research ,Good Health and Well Being ,Aged ,Aged ,80 and over ,Aspirin ,Clinical Decision-Making ,Computed Tomography Angiography ,Coronary Angiography ,Coronary Artery Disease ,Female ,Heart Disease Risk Factors ,Hemorrhage ,Humans ,Incidence ,Male ,Middle Aged ,Myocardial Infarction ,Platelet Aggregation Inhibitors ,Primary Prevention ,Prospective Studies ,Risk Assessment ,Stroke ,Time Factors ,Treatment Outcome ,United States ,Vascular Calcification ,aspirin ,calcium ,cardiovascular diseases ,hemorrhage ,risk ,safety ,Cardiorespiratory Medicine and Haematology ,Clinical Sciences ,Public Health and Health Services ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences ,Sports science and exercise - Abstract
BackgroundRecent American College of Cardiology/American Heart Association Primary Prevention Guidelines recommended considering low-dose aspirin therapy only among adults 40 to 70 years of age who are at higher atherosclerotic cardiovascular disease (ASCVD) risk but not at high risk of bleeding. However, it remains unclear how these patients are best identified. The present study aimed to assess the value of coronary artery calcium (CAC) for guiding aspirin allocation for primary prevention by using 2019 aspirin meta-analysis data on cardiovascular disease relative risk reduction and bleeding risk.MethodsThe study included 6470 participants from the MESA Study (Multi-Ethnic Study of Atherosclerosis). ASCVD risk was estimated using the pooled cohort equations, and 3 strata were defined: 20%. All participants underwent CAC scoring at baseline, and CAC scores were stratified as =0, 1 to 99, ≥100, and ≥400. A 12% relative risk reduction in cardiovascular disease events was used for the 5-year number needed to treat (NNT5) calculations, and a 42% relative risk increase in major bleeding events was used for the 5-year number needed to harm (NNH5) estimations.ResultsOnly 5% of MESA participants would qualify for aspirin consideration for primary prevention according to the American College of Cardiology/American Heart Association guidelines and using >20% estimated ASCVD risk to define higher risk. Benefit/harm calculations were restricted to aspirin-naive participants
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- 2020
23. Interplay of Coronary Artery Calcium and Risk Factors for Predicting CVD/CHD Mortality The CAC Consortium
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Grandhi, Gowtham R, Mirbolouk, Mohammadhassan, Dardari, Zeina A, Al-Mallah, Mouaz H, Rumberger, John A, Shaw, Leslee J, Blankstein, Ron, Miedema, Michael D, Berman, Daniel S, Budoff, Matthew J, Krumholz, Harlan M, Blaha, Michael J, and Nasir, Khurram
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Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Clinical Sciences ,Heart Disease - Coronary Heart Disease ,Clinical Research ,Cardiovascular ,Heart Disease ,Prevention ,Aetiology ,2.4 Surveillance and distribution ,Good Health and Well Being ,Adult ,Aged ,Cause of Death ,Computed Tomography Angiography ,Coronary Angiography ,Coronary Artery Disease ,Diabetes Mellitus ,Dyslipidemias ,Female ,Heart Disease Risk Factors ,Humans ,Hypertension ,Male ,Middle Aged ,Multidetector Computed Tomography ,Predictive Value of Tests ,Prevalence ,Prognosis ,Retrospective Studies ,Risk Assessment ,Smoking ,Time Factors ,United States ,Vascular Calcification ,coronary artery calcium ,mortal ,risk factors ,Cardiorespiratory Medicine and Haematology ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Abstract
ObjectivesThis study sought to evaluate the association and burden of coronary artery calcium (CAC) with long-term, cause-specific mortality across the spectrum of baseline risk.BackgroundAlthough CAC is a known predictor of short-term, all-cause mortality, data on long-term and cause-specific mortality are inadequate.MethodsThe CAC Consortium cohort is a multicenter cohort of 66,636 participants without coronary heart disease (CHD) who underwent CAC testing. The following risk factors (RFs) were considered: 1) current cigarette smoking; 2) dyslipidemia; 3) diabetes mellitus; 4) hypertension; and 5) family history of CHD.ResultsDuring the 12.5-years median follow-up, 3,158 (4.7%) deaths occurred; 32% were cardiovascular disease (CVD) deaths. Participants with CAC scores ≥400 had a significantly increased risk for CHD and CVD mortality (hazard ratio [HR]: 5.44; 95% confidence interval [CI]: 3.88 to 7.62; and HR: 4.15; 95% CI: 3.29 to 5.22, respectively) compared with CAC of 0. Participants with ≥3 RFs had a smaller increased risk for CHD and CVD mortality (HR: 2.09; 95% CI: 1.52 to 2.85; and HR: 1.84; 95% CI: 1.46 to 2.31, respectively) compared with those without RFs. Across RF strata, CAC added prognostic information. For example, participants without RFs but with CAC ≥400 had significantly higher all-cause, non-CVD, CVD, and CHD mortality rates compared with participants with ≥3 RFs and CAC of 0.ConclusionsAcross the spectrum of RF burden, a higher CAC score was strongly associated with long-term, all-cause mortality and a greater proportion of deaths due to CVD and CHD. Absence of CAC identified people with a low risk over 12 years of follow-up, with most deaths being non-CVD in nature, regardless of RF burden.
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- 2020
24. Predictors of coronary artery calcium among 20-30-year-olds: The Coronary Artery Calcium Consortium
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Osei, Albert D, Uddin, SM Iftekhar, Dzaye, Omar, Achirica, Miguel Cainzos, Dardari, Zeina A, Obisesan, Olufunmilayo H, Kianoush, Sina, Mirbolouk, Mohammadhassan, Orimoloye, Olusola A, Shaw, Leslee, Rumberger, John A, Berman, Daniel, Rozanski, Alan, Miedema, Michael D, Budoff, Matthew J, Vasan, Ramachandran S, Nasir, Khurram, and Blaha, Michael J
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Biomedical and Clinical Sciences ,Clinical Sciences ,Aging ,Prevention ,Heart Disease ,Cardiovascular ,Heart Disease - Coronary Heart Disease ,Atherosclerosis ,Clinical Research ,Good Health and Well Being ,Adult ,Calcium ,Cohort Studies ,Coronary Angiography ,Coronary Artery Disease ,Coronary Vessels ,Female ,Humans ,Male ,Risk Assessment ,Risk Factors ,Vascular Calcification ,Young Adult ,Coronary artery calcium ,Predictors ,Cardiovascular risk factors ,Young adults ,Cardiorespiratory Medicine and Haematology ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Abstract
Background and aimsWe sought to understand the risk factor correlates of very early coronary artery calcium (CAC), and the potential investigational value of CAC phenotyping in adults aged 20-30 years.MethodsWe studied all participants aged 20-30 years at baseline (N = 373) in the Coronary Artery Calcium Consortium, a large multi-center cohort study of patients aged 18 years or older without known atherosclerotic cardiovascular disease (ASCVD) at baseline, referred for CAC scoring for clinical risk stratification. We described the prevalence of CAC in men and women, the frequency of risk factors by the presence of CAC (CAC = 0 vs CAC >0), and assessed the association between traditional non-demographic CVD risk factors (hypertension, hyperlipidemia, smoking, family history of CHD, and diabetes) and prevalent CAC, using age- and sex-adjusted logistic regression models.ResultsThe mean age of the study participants was 27.5 ± 2.4 years; 324 (86.9%) had CAC = 0, and 49 (13.1%) had CAC >0. Among the 49 participants with CAC, 38 (77.6%) were men, and median CAC score was low at 4.6. In age- and sex-adjusted models, there was a graded increase in the odds of CAC >0 with increasing traditional cardiovascular disease (CVD) risk factor burden (p = 0.001 for linear trend). Participants with ≥3 traditional risk factors had a statistically significant higher odds of having prevalent CAC (OR 5.57, 95% CI; 1.82-17.03) compared to participants with no risk factors.ConclusionsOur study demonstrates the non-negligible prevalence of CAC among very high-risk young US adults, reinforcing the critical importance of traditional risk factors in the earliest development of detectable subclinical ASCVD.
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- 2020
25. Coronary Artery Calcium as a Synergistic Tool for the Age‐ and Sex‐Specific Risk of Cardiovascular and Cancer Mortality: The Coronary Artery Calcium Consortium
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Dzaye, Omar, Rifai, Mahmoud Al, Dardari, Zeina, Shaw, Leslee J, Al‐Mallah, Mouaz H, Marshall, Catherine Handy, Rozanski, Alan, Mortensen, Martin B, Duebgen, Matthias, Matsushita, Kunihiro, Rumberger, John A, Berman, Daniel S, Budoff, Matthew J, Miedema, Michael D, Nasir, Khurram, Blaha, Michael J, and Whelton, Seamus P
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Aging ,Heart Disease - Coronary Heart Disease ,Cardiovascular ,Heart Disease ,Prevention ,2.4 Surveillance and distribution ,Aetiology ,Good Health and Well Being ,Adult ,Age Factors ,Aged ,Cardiovascular Diseases ,Cause of Death ,Coronary Angiography ,Coronary Artery Disease ,Female ,Humans ,Male ,Middle Aged ,Neoplasms ,Predictive Value of Tests ,Prognosis ,Risk Assessment ,Risk Factors ,Severity of Illness Index ,Sex Factors ,Time Factors ,United States ,Vascular Calcification ,aging ,cardiovascular disease ,competing risk ,coronary artery calcium ,sex differences ,Cardiorespiratory Medicine and Haematology - Abstract
Background Coronary artery calcium (CAC) is a predictor for the development of cardiovascular disease (CVD) and to a lesser extent cancer. The age- and sex-specific relationship of CAC with CVD and cancer mortality is unknown. Methods and Results Asymptomatic patients aged 40 to 75 years old without known CVD were included from the CAC Consortium. We calculated sex-specific mortality rates per 1000 person-years' follow-up. Using parametric survival regression modeling, we determined the age- and sex-specific CAC score at which the risk of death from CVD and cancer were equal. Among the 59 502 patients included in this analysis, the mean age was 54.9 (±8.5) years, 34% were women, and 89% were white. There were 671 deaths attributable to CVD and 954 deaths attributable to cancer over a mean follow-up of 12±3 years. Among patients with CAC=0, cancer was the leading cause of death, the total mortality rate was low (women, 1.8; men, 1.5), and the CVD mortality rate was exceedingly low for women (0.3) and men (0.3). The age-specific CAC score at which the risk of CVD and cancer mortality were equal had a U-shaped relationship for women, while the relationship was exponential for men. Conclusions The age- and sex-specific relationship of CAC with CVD and cancer mortality differed significantly for women and men. Our age- and sex-specific CAC score provides a more precise estimate and further facilitates the use of CAC as a synergistic tool in strategies for the prediction and prevention of CVD and cancer mortality.
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- 2020
26. All-cause and cause-specific mortality in individuals with zero and minimal coronary artery calcium: A long-term, competing risk analysis in the Coronary Artery Calcium Consortium
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Blaha, Michael J, Cainzos-Achirica, Miguel, Dardari, Zeina, Blankstein, Ron, Shaw, Leslee J, Rozanski, Alan, Rumberger, John A, Dzaye, Omar, Michos, Erin D, Berman, Daniel S, Budoff, Matthew J, Miedema, Michael D, Blumenthal, Roger S, and Nasir, Khurram
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Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Clinical Sciences ,Heart Disease - Coronary Heart Disease ,Prevention ,Clinical Research ,Cardiovascular ,Aging ,Heart Disease ,2.4 Surveillance and distribution ,Aetiology ,4.2 Evaluation of markers and technologies ,Detection ,screening and diagnosis ,Good Health and Well Being ,Aged ,Coronary Artery Disease ,Female ,Humans ,Male ,Middle Aged ,Prevalence ,Retrospective Studies ,Risk Assessment ,Severity of Illness Index ,Survival Rate ,Vascular Calcification ,Cancer ,Cardiovascular disease ,Competing risks ,Coronary artery calcium ,Mortality ,Risk ,Cardiorespiratory Medicine and Haematology ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Abstract
Background and aimsThe long-term associations between zero, minimal coronary artery calcium (CAC) and cause-specific mortality are currently unknown, particularly after accounting for competing risks with other causes of death.MethodsWe evaluated 66,363 individuals from the CAC Consortium (mean age 54 years, 33% women), a multi-center, retrospective cohort study of asymptomatic individuals undergoing CAC scoring for clinical risk assessment. Baseline evaluations occurred between 1991 and 2010.ResultsOver a mean of 12 years of follow-up, individuals with CAC = 0 (45% prevalence, mean age 45 years) had stable low rates of coronary heart disease (CHD) death, cardiovascular disease (CVD) death (ranging 0.32 to 0.43 per 1000 person-years), and all-cause death (1.38-1.62 per 1000 person-years). Cancer was the predominant cause of death in this group, yet rates were also very low (0.47-0.79 per 1000 person-years). Compared to CAC = 0, individuals with CAC 1-10 had an increased multivariable-adjusted risk of CVD death only under age 40. Individuals with CAC>10 had multivariable-adjusted increased risks of CHD death, CVD death and all-cause death at all ages, and a higher proportion of CVD deaths.ConclusionsCAC = 0 is a frequent finding among individuals undergoing CAC scanning for risk assessment and is associated with low rates of all-cause death at 12 years of follow-up. Our results support the emerging consensus that CAC = 0 represents a unique population with favorable all-cause prognosis who may be considered for more flexible treatment goals in primary prevention. Detection of any CAC in young adults could be used to trigger aggressive preventive interventions.
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- 2020
27. Validation of the Coronary Artery Calcium Data and Reporting System (CAC-DRS): Dual importance of CAC score and CAC distribution from the Coronary Artery Calcium (CAC) consortium
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Dzaye, Omar, Dudum, Ramzi, Mirbolouk, Mohammadhassan, Orimoloye, Olusola A, Osei, Albert D, Dardari, Zeina A, Berman, Daniel S, Miedema, Michael D, Shaw, Leslee, Rozanski, Alan, Holdhoff, Matthias, Nasir, Khurram, Rumberger, John A, Budoff, Matthew J, Al-Mallah, Mouaz H, Blankstein, Ron, and Blaha, Michael J
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Biomedical and Clinical Sciences ,Clinical Sciences ,Prevention ,Cardiovascular ,Clinical Research ,Heart Disease - Coronary Heart Disease ,Heart Disease ,Good Health and Well Being ,Adult ,Aged ,Cause of Death ,Coronary Angiography ,Coronary Artery Disease ,Databases ,Factual ,Female ,Humans ,Male ,Middle Aged ,Predictive Value of Tests ,Prognosis ,Radiology Information Systems ,Reproducibility of Results ,Retrospective Studies ,Risk Assessment ,Risk Factors ,Severity of Illness Index ,Time Factors ,United States ,Vascular Calcification ,Coronary artery calcium data and reporting system ,Coronary artery calcium ,Computed tomography ,Cardiorespiratory Medicine and Haematology ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences ,Applied computing - Abstract
BackgroundThe Coronary Artery Calcium Data and Reporting System (CAC-DRS), which takes into account the Agatston score category (A) and the number of calcified vessels (N) has not yet been validated in terms of its prognostic significance.MethodsWe included 54,678 patients from the CAC Consortium, a large retrospective clinical cohort of asymptomatic individuals free of baseline cardiovascular disease (CVD). CAC-DRS groups were derived from routine, cardiac-gated CAC scans. Cox proportional hazards regression models, adjusted for traditional CVD risk factors, were used to assess the association between CAC-DRS groups and CHD, CVD, and all-cause mortality. CAC-DRS was then compared to CAC score groups and regional CAC distribution using area under the curve (AUC) analysis.ResultsThe study population had a mean age of 54.2 ± 10.7, 34.4% female, and mean ASCVD score 7.3% ± 9.0. Over a mean follow-up of 12 ± 4 years, a total of 2,469 deaths (including 398 CHD deaths and 762 CVD deaths) were recorded. There was a graded risk for CHD, CVD and all-cause mortality with increasing CAC-DRS groups ranging from an all-cause mortality rate of 1.2 per 1,000 person-years for A0 to 15.4 per 1,000 person-years for A3/N4. In multivariable-adjusted models, those with CAC-DRS A3/N4 had significantly higher risk for CHD mortality (HR 5.9 (95% CI 3.6-9.9), CVD mortality (HR4.0 (95% CI 2.8-5.7), and all-cause mortality a (HR 2.5 (95% CI 2.1-3.0) compared to CAC-DRS A0. CAC-DRS had higher AUC than CAC score groups (0.762 vs 0.754, P
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- 2020
28. Long-Term All-Cause and Cause-Specific Mortality in Asymptomatic Patients With CAC ≥1,000 Results From the CAC Consortium
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Peng, Allison W, Mirbolouk, Mohammadhassan, Orimoloye, Olusola A, Osei, Albert D, Dardari, Zeina, Dzaye, Omar, Budoff, Matthew J, Shaw, Leslee, Miedema, Michael D, Rumberger, John, Berman, Daniel S, Rozanski, Alan, Al-Mallah, Mouaz H, Nasir, Khurram, and Blaha, Michael J
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Biomedical and Clinical Sciences ,Clinical Sciences ,Prevention ,Heart Disease - Coronary Heart Disease ,Cardiovascular ,Cancer ,Clinical Research ,Heart Disease ,Detection ,screening and diagnosis ,4.2 Evaluation of markers and technologies ,Good Health and Well Being ,Aged ,Aged ,80 and over ,Asymptomatic Diseases ,Cause of Death ,Computed Tomography Angiography ,Coronary Angiography ,Coronary Artery Disease ,Female ,Humans ,Male ,Middle Aged ,Prognosis ,Retrospective Studies ,Risk Assessment ,Risk Factors ,Severity of Illness Index ,Time Factors ,United States ,Vascular Calcification ,cardiovascular imaging ,coronary artery calcium ,high risk ,primary prevention ,risk scoring ,Cardiorespiratory Medicine and Haematology ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Abstract
ObjectivesThis study thoroughly explored the demographic and imaging characteristics, as well as the all-cause and cause-specific mortality risks of patients with a coronary artery calcium (CAC) score ≥1,000 in the largest dataset of this population to date.BackgroundCAC is commonly used to quantify cardiovascular risk. Current guidelines classify a CAC score of >300 or 400 as the highest risk group, yet little is known about the potentially unique imaging characteristics and mortality risk in individuals with a CAC score ≥1,000.MethodsA total of 66,636 asymptomatic adults were included from the CAC consortium, a large retrospective multicenter clinical cohort. Mean patient follow-up was 12.3 ± 3.9 years for patients with cardiovascular disease (CVD), coronary heart disease (CHD), cancer, and all-cause mortality. Multivariate Cox proportional hazards regression models adjusted for age, sex, and conventional risk factors were used to assess the relative mortality hazard of individuals with CAC ≥1,000 compared with, first, a CAC reference of 0, and second, with patients with a CAC score of 400 to 999.ResultsThere were 2,869 patients with CAC ≥1,000 (86.3% male, mean 66.3 ± 9.7 years of age). Most patients with CAC ≥1,000 had 4-vessel CAC (mean: 3.5 ± 0.6 vessels) and had greater total CAC area, higher mean CAC density, and more extracoronary calcium (79% with thoracic artery calcium, 46% with aortic valve calcium, and 21% with mitral valve calcium) than those with CAC scores of 400 to 999. After full adjustment, those with CAC ≥1,000 had a 5.04- (95% confidence interval [CI]: 3.92 to 6.48), 6.79- (95% CI: 4.74 to 9.73), 1.55- (95% CI:1.23 to 1.95), and 2.89-fold (95% CI: 2.53 to 3.31) risk of CVD, CHD, cancer, and all-cause mortality, respectively, compared to those with CAC score of 0. The CAC ≥1,000 group had a 1.71- (95% CI: 1.41 to 2.08), 1.84- (95% CI: 1.43 to 2.36), 1.36- (95% CI:1.07 to 1.73), and 1.51-fold (95% CI: 1.33 to 1.70) increased risk of CVD, CHD, cancer, and all-cause mortality compared to those with CAC scores 400 to 999. Graphic analysis of CAC ≥1,000 patients revealed continued logarithmic increase in risk, with no clear evidence of a risk plateau.ConclusionsPatients with extensive CAC (CAC ≥1,000) represent a unique very high-risk phenotype with mortality outcomes commensurate with high-risk secondary prevention patients. Future guidelines should consider CAC ≥1,000 patients to be a distinct risk group who may benefit from the most aggressive preventive therapy.
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- 2020
29. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease
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Arnett, Donna K, Blumenthal, Roger S, Albert, Michelle A, Buroker, Andrew B, Goldberger, Zachary D, Hahn, Ellen J, Himmelfarb, Cheryl Dennison, Khera, Amit, Lloyd-Jones, Donald, McEvoy, J William, Michos, Erin D, Miedema, Michael D, Muñoz, Daniel, Smith, Sidney C, Virani, Salim S, Williams, Kim A, Yeboah, Joseph, and Ziaeian, Boback
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Advisory Committees ,American Heart Association ,Cardiology ,Cardiovascular Diseases ,Humans ,Practice Guidelines as Topic ,Primary Prevention ,Research Report ,United States ,AHA Scientific Statements ,guidelines ,antihypertensive agents ,aspirin ,atherosclerosis ,atherosclerotic cardiovascular disease ,atrial fibrillation ,behavior modification ,behavior therapy ,blood cholesterol ,blood pressure ,body mass index ,cardiovascular team-based care ,cardiovascular ,cardiovascular disease ,cholesterol ,chronic kidney disease ,coronary artery calcium score ,coronary disease ,coronary heart disease ,cost ,diet ,dietary patterns ,dietary fats ,dietary sodium ,dyslipidemia ,e-cigarettes ,exercise ,healthcare disparities ,health services accessibility ,heart failure ,hypertension ,LDL cholesterol ,diabetes mellitus ,lifestyle ,lipids ,measurement ,myocardial infarction ,nicotine ,nonpharmacological treatment ,nutrition ,physical activity ,prejudice ,primary prevention ,psychosocial deprivation ,public health ,quality indicators ,quality measurement ,risk assessment ,risk-enhancing factors ,risk factors ,risk reduction ,risk reduction discussion ,risk treatment discussion ,secondhand smoke ,sleep ,smoking ,smoking cessation ,social determinants of health ,socioeconomic factors ,statin therapy ,systems of care ,tobacco ,tobacco smoke pollution ,treatment adherence ,treatment outcomes ,type 2 diabetes mellitus ,waist circumference ,weight loss ,Cardiorespiratory Medicine and Haematology ,Clinical Sciences ,Public Health and Health Services ,Cardiovascular System & Hematology - Published
- 2019
30. Correction to: 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
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Arnett, Donna K, Blumenthal, Roger S, Albert, Michelle A, Buroker, Andrew B, Goldberger, Zachary D, Hahn, Ellen J, Himmelfarb, Cheryl Dennison, Khera, Amit, Lloyd-Jones, Donald, McEvoy, J William, Michos, Erin D, Miedema, Michael D, Munoz, Daniel, Smith, Sidney C Jr, Virani, Salim S, Williams, Kim A Sr, Yeboah, Joseph, and Ziaeian, Boback
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Epidemiology ,Biomedical and Clinical Sciences ,Health Sciences ,Cardiovascular ,Good Health and Well Being ,Cardiorespiratory Medicine and Haematology ,Clinical Sciences ,Public Health and Health Services ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences ,Sports science and exercise - Published
- 2019
31. Correction to: 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
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Arnett, Donna K, Blumenthal, Roger S, Albert, Michelle A, Buroker, Andrew B, Goldberger, Zachary D, Hahn, Ellen J, Himmelfarb, Cheryl Dennison, Khera, Amit, Lloyd-Jones, Donald, McEvoy, J William, Michos, Erin D, Miedema, Michael D, Munoz, Daniel, Smith, Sidney C Jr, Virani, Salim S, Williams, Kim A Sr, Yeboah, Joseph, and Ziaeian, Boback
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Epidemiology ,Biomedical and Clinical Sciences ,Health Sciences ,Cardiovascular ,Good Health and Well Being ,Cardiorespiratory Medicine and Haematology ,Clinical Sciences ,Public Health and Health Services ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences ,Sports science and exercise - Published
- 2019
32. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
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Arnett, Donna K, Blumenthal, Roger S, Albert, Michelle A, Buroker, Andrew B, Goldberger, Zachary D, Hahn, Ellen J, Himmelfarb, Cheryl Dennison, Khera, Amit, Lloyd-Jones, Donald, McEvoy, J William, Michos, Erin D, Miedema, Michael D, Muñoz, Daniel, Smith, Sidney C, Virani, Salim S, Williams, Kim A, Yeboah, Joseph, and Ziaeian, Boback
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Good Health and Well Being ,Advisory Committees ,Cardiovascular Diseases ,Humans ,Primary Prevention ,ACC/AHA Clinical Practice Guidelines ,guidelines ,antihypertensive agents ,aspirin ,atherosclerosis atherosclerotic ,cardiovascular disease ,atrial fibrillation ,behavior modification ,behavior therapy ,blood cholesterol ,blood pressure ,body mass ,index ,cardiovascular team-based care ,cardiovascular ,cholesterol ,chronic kidney disease ,coronary artery calcium score ,coronary disease ,coronary heart disease ,cost ,diet ,dietary patterns ,dietary fats ,dietary ,sodium ,dyslipidemia ,e-cigarettes ,exercise ,healthcare disparities ,health services ,accessibility ,heart failure ,hypertension ,LDL-cholesterol ,diabetes mellitus ,lifestyle ,lipids ,measurement ,myocardial infarction ,nicotine ,nonpharmacological treatment ,nutrition ,physical activity ,prejudice ,primary prevention ,psychosocial deprivation ,public health ,quality ,indicators ,quality measurement ,risk ,assessment ,risk-enhancing factors ,risk factors ,risk reduction ,risk reduction discussion ,treatment discussion ,secondhand smoke ,sleep ,smoking ,smoking cessation ,social determinants ,of health ,socioeconomic factors ,statin therapy ,systems of care ,tobacco ,tobacco smoke ,pollution ,treatment adherence ,treatment ,outcomes ,type 2 diabetes mellitus ,waist ,circumference ,weight loss ,atherosclerosis ,atherosclerotic cardiovascular disease ,dietary sodium ,health services accessibility ,quality indicators ,risk assessment ,risk treatment discussion ,social determinants of health ,tobacco smoke pollution ,treatment outcomes ,waist circumference ,Cardiorespiratory Medicine and Haematology ,Public Health and Health Services ,Cardiovascular System & Hematology - Published
- 2019
33. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
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Arnett, Donna K, Blumenthal, Roger S, Albert, Michelle A, Buroker, Andrew B, Goldberger, Zachary D, Hahn, Ellen J, Himmelfarb, Cheryl Dennison, Khera, Amit, Lloyd-Jones, Donald, McEvoy, J William, Michos, Erin D, Miedema, Michael D, Muñoz, Daniel, Smith, Sidney C, Virani, Salim S, Williams, Kim A, Yeboah, Joseph, and Ziaeian, Boback
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ACC/AHA Clinical Practice Guidelines ,LDL-cholesterol ,antihypertensive agents ,aspirin ,atherosclerosis ,atherosclerotic cardiovascular disease ,atrial fibrillation ,behavior modification ,behavior therapy ,blood cholesterol ,blood pressure ,body mass index ,cardiovascular ,cardiovascular disease ,cardiovascular team-based care ,cholesterol ,chronic kidney disease ,coronary artery calcium score ,coronary disease ,coronary heart disease ,cost ,diabetes mellitus ,diet ,dietary fats ,dietary patterns ,dietary sodium ,dyslipidemia ,e-cigarettes ,exercise ,guidelines ,health services accessibility ,healthcare disparities ,heart failure ,hypertension ,lifestyle ,lipids ,measurement ,myocardial infarction ,nicotine ,nonpharmacological treatment ,nutrition ,physical activity ,prejudice ,primary prevention ,psychosocial deprivation ,public health ,quality indicators ,quality measurement ,risk assessment ,risk factors ,risk reduction ,risk reduction discussion ,risk treatment discussion ,risk-enhancing factors ,secondhand smoke ,sleep ,smoking ,smoking cessation ,social determinants of health ,socioeconomic factors ,statin therapy ,systems of care ,tobacco ,tobacco smoke pollution ,treatment adherence ,treatment outcomes ,type 2 diabetes mellitus ,waist circumference ,weight loss ,Cardiovascular System & Hematology ,Cardiorespiratory Medicine and Haematology ,Public Health and Health Services - Published
- 2019
34. Mortality impact of low CAC density predominantly occurs in early atherosclerosis: explainable ML in the CAC consortium
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Lin, Fay Y., Goebel, Benjamin P., Lee, Benjamin C., Lu, Yao, Baskaran, Lohendran, Yoon, Yeonyee E., Maliakal, Gabriel Thomas, Gianni, Umberto, Bax, A. Maxim, Sengupta, Partho P., Slomka, Piotr J., Dey, Damini S., Rozanski, Alan, Han, Donghee, Berman, Daniel S., Budoff, Matthew J., Miedema, Michael D., Nasir, Khurram, Rumberger, John, Whelton, Seamus P., Blaha, Michael J., and Shaw, Leslee J.
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- 2023
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35. Coronary Artery Calcium for Risk Assessment in Young Adults
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Haq, Ayman and Miedema, Michael D.
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- 2022
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36. Discordance Between Coronary Artery Calcium Area and Density Predicts Long-Term Atherosclerotic Cardiovascular Disease Risk
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Razavi, Alexander C., van Assen, Marly, De Cecco, Carlo N., Dardari, Zeina A., Berman, Daniel S., Budoff, Matthew J., Miedema, Michael D., Nasir, Khurram, Rozanski, Alan, Rumberger, John A., Shaw, Leslee J., Sperling, Laurence S., Whelton, Seamus P., Mortensen, Martin Bødtker, Blaha, Michael J., and Dzaye, Omar
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- 2022
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37. RACIAL AND ETHNIC DIFFERENCES IN LONG-TERM CARDIOVASCULAR MORTALITY AMONG WOMEN AND MEN FROM THE CAC CONSORTIUM
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Rosenblatt, Shmuel, primary, Blaha, Michael J., additional, Blankstein, Ron, additional, Yeboah-Kordieh, Yvette, additional, Nasir, Khurram, additional, Lin, Fay, additional, Berman, Daniel S., additional, Miedema, Michael D., additional, Whelton, Seamus P., additional, Rumberger, John, additional, Budoff, Matthew J., additional, Leipsic, Jonathon, additional, and Shaw, Leslee J., additional
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- 2024
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38. Clinical characteristics and statin eligibility of patients under 50 with ST‐elevation myocardial infarction
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Haq, Ayman, primary, Walser‐Kuntz, Evan, additional, Gamam, Abdulrahman, additional, Albers, Alexis, additional, Bae, Aaron, additional, Benson, Gretchen, additional, and Miedema, Michael D., additional
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- 2024
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39. Association of Coronary Artery Calcium With Long-term, Cause-Specific Mortality Among Young Adults
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Miedema, Michael D, Dardari, Zeina A, Nasir, Khurram, Blankstein, Ron, Knickelbine, Thomas, Oberembt, Sandra, Shaw, Leslee, Rumberger, John, Michos, Erin D, Rozanski, Alan, Berman, Daniel S, Budoff, Matthew J, and Blaha, Michael J
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Biomedical and Clinical Sciences ,Epidemiology ,Public Health ,Health Sciences ,Clinical Sciences ,Aging ,Heart Disease ,Heart Disease - Coronary Heart Disease ,Cardiovascular ,Clinical Research ,Prevention ,Aetiology ,4.2 Evaluation of markers and technologies ,2.4 Surveillance and distribution ,Detection ,screening and diagnosis ,Good Health and Well Being ,Adult ,Cardiovascular Diseases ,Cause of Death ,Coronary Artery Disease ,Female ,Humans ,Male ,Middle Aged ,Prevalence ,Proportional Hazards Models ,Regression Analysis ,Retrospective Studies ,Risk Assessment ,Risk Factors ,Vascular Calcification ,Biomedical and clinical sciences ,Health sciences - Abstract
ImportanceThe level of coronary artery calcium (CAC) can effectively stratify cardiovascular risk in middle-aged and older adults, but its utility for young adults is unclear.ObjectivesTo determine the prevalence of CAC in adults aged 30 to 49 years and the subsequent association of CAC with coronary heart disease (CHD), cardiovascular disease (CVD), and all-cause mortality.Design, setting, and participantsA multicenter retrospective cohort study was conducted among 22 346 individuals from the CAC Consortium who underwent CAC testing (baseline examination, 1991-2010, with follow-up through June 30, 2014; CAC quantified using nonconrast, cardiac-gated computed tomography scans) for clinical indications and were followed up for cause-specific mortality. Participants were free of clinical CVD at baseline. Statistical analysis was performed from June 1, 2017, to May 31, 2018.Main outcomes and measuresThe prevalence of CAC and the subsequent rates of CHD, CVD, and all-cause mortality. Competing risks regression modeling was used to calculate multivariable-adjusted subdistribution hazard ratios for CHD and CVD mortality.ResultsThe sample of 22 346 participants (25.0% women and 75.0% men; mean [SD] age, 43.5 [4.5] years) had a high prevalence of hyperlipidemia (49.6%) and family history of CHD (49.3%) but a low prevalence of current smoking (11.0%) and diabetes (3.9%). The prevalence of any CAC was 34.4%, with 7.2% having a CAC score of more than 100. During follow-up (mean [SD], 12.7 [4.0] years), there were 40 deaths related to CHD, 84 deaths related to CVD, and 298 total deaths. A total of 27 deaths related to CHD (67.5%) occurred among individuals with CAC at baseline. The CHD mortality rate per 1000 person-years was 10-fold higher among those with a CAC score of more than 100 (0.69; 95% CI, 0.41-1.16) compared with those with a CAC score of 0 (0.07; 95% CI, 0.04-0.12). After multivariable adjustment, those with a CAC score of more than 100 had a significantly increased risk of CHD (subdistribution hazard ratio, 5.6; 95% CI, 2.5-12.7), CVD (subdistribution hazard ratio, 3.3; 95% CI, 1.8-6.2), and all-cause mortality (hazard ratio, 2.6; 95% CI, 1.9-3.6) compared with those with a CAC score of 0.Conclusions and relevanceIn a large sample of young adults undergoing CAC testing for clinical indications, 34.4% had CAC, and those with elevated CAC scores had significantly higher rates of CHD and CVD mortality. Coronary artery calcium may have potential utility for clinical decision-making among select young adults at elevated risk of cardiovascular disease.
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- 2019
40. The association between left main coronary artery calcium and cardiovascular-specific and total mortality: The Coronary Artery Calcium Consortium
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Lahti, Steven J, Feldman, David I, Dardari, Zeina, Mirbolouk, Mohammadhassan, Orimoloye, Olusola A, Osei, Albert D, Graham, Garth, Rumberger, John, Shaw, Leslee, Budoff, Matthew J, Rozanski, Alan, Miedema, Michael D, Al-Mallah, Mouaz H, Berman, Dan, Nasir, Khurram, and Blaha, Michael J
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Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Clinical Sciences ,Heart Disease - Coronary Heart Disease ,Heart Disease ,Cardiovascular ,Prevention ,Detection ,screening and diagnosis ,4.2 Evaluation of markers and technologies ,Good Health and Well Being ,Aged ,Cardiovascular Diseases ,Cohort Studies ,Coronary Artery Disease ,Female ,Humans ,Male ,Middle Aged ,Retrospective Studies ,Risk Assessment ,Risk Factors ,Vascular Calcification ,Coronary artery calcium ,Left-main atherosclerosis ,Screening ,Cardiovascular risk ,Cardiorespiratory Medicine and Haematology ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Abstract
Background and aimsLeft main (LM) coronary artery disease is associated with greater myocardial infarction-related mortality, however, coronary artery calcium (CAC) scoring does not account for disease location. We explored whether LM CAC predicts excess mortality in asymptomatic adults.MethodsCause-specific cardiovascular and all-cause mortality was studied in 28,147 asymptomatic patients with non-zero CAC scores in the CAC Consortium. Multivariate regression was performed to evaluate if the presence and burden of LM CAC predict mortality after adjustment for clinical risk factors and the Agatston CAC score. We further analyzed the per-unit hazard associated with LM CAC in comparison to CAC in other arteries.ResultsThe study population had mean age of 58.3 ± 10 years and CAC score of 301 ± 631. LM CAC was present in 21.7% of the cases. During 312,398 patient-years of follow-up, 1,907 deaths were observed. LM CAC was associated with an increased burden of clinical risk factors and total CAC, and was independently predictive of increased hazard for all-cause (HR 1.2 [1.1, 1.3]) and cardiovascular disease death (HR 1.3 [1.1, 1.5]). The hazard for death increased proportionate to the percentage of CAC localized to the LM. On a per-100 Agatston unit basis, LM CAC was associated with a 6-9% incremental hazard for death beyond knowledge of CAC in other arteries.ConclusionsThe presence and high burden of left main CAC are independently associated with a 20-30% greater hazard for cardiovascular and total mortality in asymptomatic adults, arguing that LM CAC should be routinely noted in CAC score reports when present.
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- 2019
41. Coronary artery calcium scoring in low risk patients with family history of coronary heart disease: Validation of the SCCT guideline approach in the coronary artery calcium consortium
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Dudum, Ramzi, Dzaye, Omar, Mirbolouk, Mohammadhassan, Dardari, Zeina A, Orimoloye, Olusola A, Budoff, Matthew J, Berman, Daniel S, Rozanski, Alan, Miedema, Michael D, Nasir, Khurram, Rumberger, John A, Shaw, Leslee, Whelton, Seamus P, Graham, Garth, and Blaha, Michael J
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Biomedical and Clinical Sciences ,Clinical Sciences ,Heart Disease ,Clinical Research ,Cardiovascular ,Prevention ,Atherosclerosis ,Aging ,Heart Disease - Coronary Heart Disease ,Aetiology ,2.4 Surveillance and distribution ,4.2 Evaluation of markers and technologies ,4.1 Discovery and preclinical testing of markers and technologies ,Detection ,screening and diagnosis ,Good Health and Well Being ,Adult ,Computed Tomography Angiography ,Coronary Angiography ,Coronary Artery Disease ,Databases ,Factual ,Female ,Genetic Predisposition to Disease ,Humans ,Male ,Middle Aged ,Pedigree ,Phenotype ,Practice Guidelines as Topic ,Predictive Value of Tests ,Prognosis ,Reproducibility of Results ,Retrospective Studies ,Risk Assessment ,Risk Factors ,Severity of Illness Index ,Time Factors ,United States ,Vascular Calcification ,Coronary artery calcium ,Computed tomography ,Coronary heart disease ,Family history ,Cardiorespiratory Medicine and Haematology ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences ,Applied computing - Abstract
BACKGROUND:The Society of Cardiovascular Computed Tomography (SCCT) recommends consideration of coronary artery calcium (CAC) scoring among individuals with a family history (FH) of coronary heart disease (CHD) and atherosclerotic cardiovascular disease (ASCVD) risk 100 had a 2.2 (95% CI 1.5-3.3) higher risk of all-cause mortality, 4.3 (95% CI 1.9-9.5) times higher risk of CVD-specific mortality, and a 10.4 (95% CI 3.2-33.7) times higher risk of CHD-specific mortality compared to individuals with CAC = 0. The NNS to detect CAC >100 in this sample was 9. CONCLUSION:In otherwise low risk patients with FH of CHD, CAC>100 were associated with increased risk of all-cause and CHD mortality with event rates in a range that may benefit with preventive pharmacotherapy. These data strongly support new SCCT recommendations regarding testing of patients with a family history of CHD.
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- 2019
42. Role of Coronary Artery Calcium for Stratifying Cardiovascular Risk in Adults With Hypertension
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Uddin, SM Iftekhar, Mirbolouk, Mohammadhassan, Kianoush, Sina, Orimoloye, Olusola A, Dardari, Zeina, Whelton, Seamus P, Miedema, Michael D, Nasir, Khurram, Rumberger, John A, Shaw, Leslee J, Berman, Daniel S, Budoff, Matthew J, McEvoy, John W, Matsushita, Kunihiro, Blaha, Michael J, and Graham, Garth
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Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Clinical Sciences ,Aging ,Prevention ,Cardiovascular ,Atherosclerosis ,Clinical Trials and Supportive Activities ,Clinical Research ,Heart Disease ,Heart Disease - Coronary Heart Disease ,Hypertension ,4.1 Discovery and preclinical testing of markers and technologies ,Detection ,screening and diagnosis ,Good Health and Well Being ,Aged ,Blood Pressure ,Calcinosis ,Calcium ,Cardiovascular Diseases ,Cause of Death ,Coronary Angiography ,Coronary Artery Disease ,Coronary Vessels ,Female ,Follow-Up Studies ,Humans ,Incidence ,Male ,Middle Aged ,Retrospective Studies ,Risk Assessment ,Survival Rate ,Tomography ,X-Ray Computed ,United States ,blood pressure ,calcium ,cardiovascular disease ,hypertension ,risk ,Cardiorespiratory Medicine and Haematology ,Public Health and Health Services ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Abstract
We examined the utility of coronary artery calcium (CAC) for cardiovascular risk stratification among hypertensive adults, including those fitting eligibility for SPRINT (Systolic Blood Pressure Intervention Trial). Additionally, we used CAC to identify hypertensive adults with cardiovascular disease (CVD) mortality rates equivalent to those observed in SPRINT who may, therefore, benefit from the most intensive blood pressure therapy. Our study population included 16 167 hypertensive patients from the CAC Consortium, among whom 6375 constituted a "SPRINT-like" population. We compared multivariable-adjusted hazard ratios of coronary heart disease and CVD deaths by CAC category (0, 1-99, 100-399, ≥400). Additionally, we generated a CAC-CVD mortality curve for patients aged >50 years to determine what CAC scores were associated with CVD death rates observed in SPRINT. Mean age was 58.1±10.6 years. During a mean follow-up of 11.6±3.6 years, there were 409 CVD deaths and 207 coronary heart disease deaths. Increasing CAC scores were associated with increased coronary heart disease and CVD mortality (coronary heart disease-CAC 100-399: hazard ratio [95% CI] 1.88 [1.04-3.40], CAC ≥400: 4.16 [2.34-7.39]; CVD-CAC 100-399: 1.93 [1.31-2.83], CAC ≥400: 3.51 [2.40-5.13]). A similar increased risk was observed across 10-year atherosclerotic CVD risk categories and in the SPRINT-like population. A CAC score of 220 (confidence range, 165-270) was associated with the CVD mortality rate observed in SPRINT. CAC risk stratifies adults with hypertension, including those who are SPRINT eligible. A CAC score of 220 can identify hypertensive adults with SPRINT-level CVD mortality risk and, therefore, may be reasonable for identifying candidates for aggressive blood pressure therapy.
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- 2019
43. Coronary artery calcium and the competing long-term risk of cardiovascular vs. cancer mortality: the CAC Consortium
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Whelton, Seamus P, Rifai, Mahmoud Al, Dardari, Zeina, Shaw, Leslee J, Al-Mallah, Mouaz H, Matsushita, Kunihiro, Rumberger, John A, Berman, Daniel S, Budoff, Matthew J, Miedema, Michael D, Nasir, Khurram, and Blaha, Michael J
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Clinical Research ,Prevention ,Cancer ,Cardiovascular ,Heart Disease ,Aging ,Detection ,screening and diagnosis ,4.1 Discovery and preclinical testing of markers and technologies ,Good Health and Well Being ,Adult ,Aged ,Cardiovascular Diseases ,Computed Tomography Angiography ,Coronary Angiography ,Coronary Artery Disease ,Coronary Vessels ,Female ,Humans ,Male ,Middle Aged ,Neoplasms ,Retrospective Studies ,Risk Factors ,United States ,Vascular Calcification ,CAC ,competing risk ,mortality ,risk prediction ,primary prevention ,Cardiorespiratory Medicine and Haematology ,Cardiovascular System & Hematology - Abstract
AimsCoronary artery calcium (CAC) is the strongest predictor of cardiovascular disease (CVD), yet is also associated with chronic non-CVD such as cancer. We performed this analysis in order to describe the association of CAC with CVD vs. cancer mortality.Methods and resultsThe CAC Consortium is comprised of 66 636 scans performed in asymptomatic patients without known CVD. The mean age was 54 ± 11 years and 67% of participants were men. Cause of death was ascertained from death certificates. The association of CAC with cause-specific mortality was calculated using Fine and Gray sub-distribution hazard ratio (SHR) models, which account for competing causes of death. There were 3158 deaths over a median 12 ± 4 years follow-up (37% cancer and 32% CVD). Cancer was the leading cause of death when CAC = 0 (50%) with CVD overtaking cancer when baseline CAC >300. Compared to participants with CAC = 0, the SHR for CVD mortality was 1.44 [95% confidence interval (CI) 1.14-1.81], 2.26 (95% CI 1.76-2.90), and 3.68 (95% CI 2.90-4.67) for patients with CAC 1-99, 100-299, and ≥300, and the SHR for cancer was 1.04 (95% CI 0.88-1.23), 1.19 (95% CI 0.98-1.46), and 1.30 (95% CI 1.07-1.58).ConclusionCancer was the leading cause of death for patients with baseline CAC = 0, whereas CVD overtook cancer above a threshold of CAC >300. These results argue for a focused approach for patients at the extremes of CAC scoring while suggesting that combined CVD and cancer primary prevention strategies for patients with intermediate CAC scores may significantly decrease mortality from the two leading causes of death.
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- 2019
44. Sex differences in calcified plaque and long-term cardiovascular mortality: observations from the CAC Consortium.
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Shaw, Leslee J, Min, James K, Nasir, Khurram, Xie, Joe X, Berman, Daniel S, Miedema, Michael D, Whelton, Seamus P, Dardari, Zeina A, Rozanski, Alan, Rumberger, John, Bairey Merz, C Noel, Al-Mallah, Mouaz H, Budoff, Matthew J, and Blaha, Michael J
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Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Clinical Sciences ,Aging ,Heart Disease ,Clinical Research ,Atherosclerosis ,Prevention ,Cardiovascular ,Good Health and Well Being ,Adult ,Aged ,Aged ,80 and over ,Cardiovascular Diseases ,Female ,Follow-Up Studies ,Humans ,Male ,Middle Aged ,Plaque ,Atherosclerotic ,Prognosis ,Risk Factors ,Sex Distribution ,Vascular Calcification ,Cardiovascular disease ,Coronary calcium ,Sex differences ,Cardiorespiratory Medicine and Haematology ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Abstract
AimsPathologic evidence supports unique sex-specific mechanisms as precursors for acute cardiovascular (CV) events. Current evidence on long-term CV risk among women when compared with men based on measures of coronary artery calcium (CAC) remains incomplete.Methods and resultsA total of 63 215 asymptomatic women and men were enrolled in the multicentre, CAC Consortium with median follow-up of 12.6 years. Pooled cohort equation (PCE) risk scores and risk factor data were collected with the Agatston score and other CAC measures (number of lesions and vessels, lesion size, volume, and plaque density). Cox proportional hazard models were employed to estimate CV mortality (n = 919). Sex interactions were calculated. Women and men had average PCE risk scores of 5.8% and 9.1% (P
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- 2018
45. Race/Ethnicity and the Prognostic Implications of Coronary Artery Calcium for All‐Cause and Cardiovascular Disease Mortality: The Coronary Artery Calcium Consortium
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Orimoloye, Olusola A, Budoff, Matthew J, Dardari, Zeina A, Mirbolouk, Mohammadhassan, Uddin, SM Iftekhar, Berman, Daniel S, Rozanski, Alan, Shaw, Leslee J, Rumberger, John A, Nasir, Khurram, Miedema, Michael D, Blumenthal, Roger S, and Blaha, Michael J
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Prevention ,Heart Disease ,Clinical Research ,Cardiovascular ,Atherosclerosis ,Heart Disease - Coronary Heart Disease ,Good Health and Well Being ,African Americans ,Aged ,California ,Cause of Death ,Coronary Artery Disease ,Female ,Hispanic or Latino ,Humans ,Kaplan-Meier Estimate ,Male ,Minnesota ,Ohio ,Prevalence ,Prognosis ,Prospective Studies ,Risk Factors ,Vascular Calcification ,coronary artery calcium ,health disparities ,race and ethnicity ,risk prediction ,Black or African American ,Cardiorespiratory Medicine and Haematology - Abstract
Background Coronary artery calcium (CAC) predicts cardiovascular disease (CVD) events; however, less is known about how its prognostic implications vary by race/ethnicity. Methods and Results A total of 38 277 whites, 1621 Asians, 977 blacks, and 1349 Hispanics from the CAC Consortium (mean age 55 years, 35% women) were followed over a median of 11.7 years. Modeling CAC in continuous and categorical (CAC=0; CAC 1-99; CAC 100-399; CAC ≥400) forms, we assessed its predictive value for all-cause and CVD mortality by race/ethnicity using Cox proportional hazards and Fine and Gray competing-risk regression, respectively. We also assessed the impact of race/ethnicity on risk within individual CAC strata, using whites as the reference. Models were adjusted for traditional cardiovascular risk factors. Increased CAC was associated with higher total and CVD mortality risk in all race/ethnicity groups, including Asians. However, the risk gradient with increasing CAC was more pronounced in blacks and Hispanics. In Fine and Gray subdistribution hazards models adjusted for traditional cardiovascular risk factors and CAC (continuous), blacks (subdistribution hazard ratio 3.4, 95% confidence interval, 2.5-4.8) and Hispanics (subdistribution hazard ratio 2.3, 95% confidence interval, 1.6-3.2) showed greater risk of CVD mortality when compared with whites, while Asians had risk similar to whites. These race/ethnic differences persisted when CAC=0. Conclusions CAC predicts all-cause and CVD mortality in all studied race/ethnicity groups, including Asians and Hispanics, who may be poorly represented by the Pooled Cohort Equations. Blacks and Hispanics may have greater mortality risk compared with whites and Asians after adjusting for atherosclerosis burden, with potential implications for US race/ethnic healthcare disparities research.
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- 2018
46. The prognostic value of high sensitivity C-reactive protein in a multi-ethnic population after >10 years of follow-up: The Multi-Ethnic Study of Atherosclerosis (MESA)
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Cainzos-Achirica, Miguel, Miedema, Michael D, McEvoy, John W, Cushman, Mary, Dardari, Zeina, Greenland, Philip, Nasir, Khurram, Budoff, Matthew J, Al-Mallah, Mouaz H, Yeboah, Joseph, Blumenthal, Roger S, Comin-Colet, Josep, and Blaha, Michael J
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Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Cardiovascular ,Atherosclerosis ,Prevention ,Heart Disease ,Good Health and Well Being ,Aged ,Atrial Fibrillation ,C-Reactive Protein ,Cause of Death ,Cohort Studies ,Ethnicity ,Female ,Heart Failure ,Humans ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,Incidence ,Male ,Middle Aged ,Neoplasms ,Predictive Value of Tests ,Prognosis ,Proportional Hazards Models ,Risk Assessment ,United States ,Venous Thromboembolism ,Inflammation ,C-reactive protein ,Prediction ,Cardiovascular disease ,Heart failure ,Cardiorespiratory Medicine and Haematology ,Public Health and Health Services ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology - Abstract
BackgroundThe prognostic value of hsCRP in contemporary multi-ethnic populations is unclear, particularly in statin users. The aim of this study was to characterize the prognostic utility of hsCRP for atherosclerotic CVD (ASCVD) risk prediction in a multi-ethnic population including non-users and users of statins followed for >13 years. Associations with heart failure (HF), atrial fibrillation (AF), venous thromboembolism (VTE), cancer, and all-cause death were also examined.Methods and resultsWe evaluated 6757 participants from the Multi-Ethnic Study of Atherosclerosis (MESA; 1002 using statins at baseline), median follow-up 13.2 years. Higher levels of hsCRP were associated with a higher risk of all study endpoints in the unadjusted Cox Proportional Hazards regression analyses, except AF. Among non-users of statins, hsCRP only remained associated with VTE after adjusting for ASCVD risk factors, and did not improve risk prediction. Among users of statins, hsCRP did not improve ASCVD risk prediction either, although it was strongly associated with incident HF (HR for hsCRP ≥ 2 vs
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- 2018
47. Abstract 14238: Coronary Artery Calcium for Stroke Mortality Prediction: The Coronary Artery Calcium Consortium
- Author
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Erhabor, John, Boakye, Ellen, Dardari, Zeina A, Osei, Albert D, Obisesan, Olufunmilayo, Jha, Kunal, Kumar, Sant J, Rosanski, Alan, Berman, Daniel, Budoff, Matthew, Miedema, Michael D, Johansen, Michelle C, Nasir, Khurram, Rumberger, John A, Shaw, Leslee J, and Blaha, Michael J
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- 2022
- Full Text
- View/download PDF
48. Abstract 13667: Coronary Artery Calcium for the Prediction of All-Cause and Cause-Specific Mortality Among Individuals With Obesity: The Coronary Artery Calcium Consortium
- Author
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Boakye, Ellen, Dardari, Zeina A, Erhabor, John, Osei, Albert, Obisesan, Olufunmilayo, Jha, Kunal, Kumar, Sant J, Rosanski, Alan, Berman, Daniel S, Budoff, Matthew, Miedema, Michael D, Nasir, Khurram, Rumberger, John A, Shaw, Leslee J, and Blaha, Michael J
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- 2022
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- View/download PDF
49. Abstract 13648: Risk Profile and Prognostic Implications of Premature Advanced Atherosclerotic Disease Among Young Adults: The Coronary Artery Calcium Consortium
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Boakye, Ellen, Dardari, Zeina A, Osuji, Ngozi, Erhabor, John, Obisesan, Olufunmilayo, Osei, Albert, Dzaye, Omar, Jha, Kunal, Rosanski, Alan, Berman, Daniel S, Budoff, Matthew, Miedema, Michael D, Nasir, Khurram, Rumberger, John A, Shaw, Leslee J, and Blaha, Michael J
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- 2022
- Full Text
- View/download PDF
50. Thoracic extra-coronary calcification for the prediction of stroke: The Multi-Ethnic Study of Atherosclerosis
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Kianoush, Sina, Al Rifai, Mahmoud, Cainzos-Achirica, Miguel, Al-Mallah, Mouaz H, Tison, Geoffrey H, Yeboah, Joseph, Miedema, Michael D, Allison, Matthew A, Wong, Nathan D, DeFilippis, Andrew P, Longstreth, William, Nasir, Khurram, Budoff, Matthew J, Matsushita, Kunihiro, and Blaha, Michael J
- Subjects
Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Clinical Sciences ,Heart Disease - Coronary Heart Disease ,Aging ,Stroke ,Prevention ,Cardiovascular ,Atherosclerosis ,Cerebrovascular ,Brain Disorders ,Heart Disease ,Good Health and Well Being ,Aged ,Aged ,80 and over ,Aorta ,Thoracic ,Calcinosis ,Comorbidity ,Ethnicity ,Female ,Follow-Up Studies ,Hemorrhage ,Humans ,Incidence ,Ischemia ,Ischemic Attack ,Transient ,Longitudinal Studies ,Male ,Middle Aged ,Multivariate Analysis ,Predictive Value of Tests ,Risk Factors ,Tomography ,X-Ray Computed ,Cardiovascular disease ,Coronary artery calcium ,Extracoronary calcium ,Risk prediction ,Cardiorespiratory Medicine and Haematology ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Abstract
Background and aimsAtherosclerosis is a systemic disease. We examined whether the cumulative burden of thoracic extra-coronary calcification (ECC) improves prediction of stroke, transient ischemic attack (TIA), and stroke mortality beyond traditional risk factors and coronary artery calcium (CAC).MethodsWe followed a total of 6805 participants (mean age 62.1 ± 10.2 years, 47.2% male) from the Multi-Ethnic Study of Atherosclerosis (MESA) over a median of 12.1 years. The presence or absence of calcification at 4 thoracic ECC sites (mitral valve annulus, aortic valve, aortic root, and thoracic aorta) was determined from baseline cardiac-gated non-contrast CT scans. A multisite thoracic ECC score, ranging 0-4, was calculated by summing the 4 individual sites, which were treated as binary variables. Multivariable Cox proportional hazards regression models, controlled for traditional risk factors and CAC, were used to estimate hazard ratios for ischemic (primary endpoint) and hemorrhagic stroke, total stroke, TIA, and stroke mortality with increasing thoracic ECC.ResultsWith an increasing number of thoracic ECC sites, there was a significant (p 0.10).ConclusionsAlthough multisite thoracic ECC is independently associated with ischemic stroke, total stroke, and TIA, the incremental predictive value of thoracic ECC beyond traditional risk factors and CAC appears to be minimal.
- Published
- 2017
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