Highlights
- •We repeated CAC measurement after 5 years in the Heinz Nixdorf Recall Study.
- •In the 1261 subjects having no CAC at baseline we found that traditional CVD risk factors are associated with incident CAC.
- •Women reach a given CAC onset probability 10 years later than men.
- •The extent of CAC among those who developed CAC does not differ between sexes.
- •CAC onset is accelerated by appr. 10 years in present vs. never smokers (middle-aged men and middle-aged to elderly women).
Abstract
Background
Coronary artery calcium (CAC) indicates coronary atherosclerosis and can be present
in very early stages of the disease. The conversion from no CAC to any CAC reflects
an important step of the disease process as cardiovascular risk is increased in persons
even with mildly elevated CAC. We sought to identify risk factors that determined
incident CAC>0 in men and women from an unselected general population with a special
focus on the role of smoking.
Methods
All 4814 persons that were initially studied in the Heinz Nixdorf Recall Study were
invited to participate in the follow-up examination after 5.1 ± 0.3 years. All traditional
Framingham risk factors were quantified using standard techniques. Smokers were categorized
in never, former and present smokers. The CAC scores were measured from EBCT using
the Agatston method.
Results
Overall, out of 342 men and 919 women with zero CAC at baseline, 107 (31.3%) men and
210 (22.9%) women had CAC>0 at second examination. In multivariable analysis, age
(OR estimate per 5 years: 1.34 (95%CI: 1.21–1.47)), LDL cholesterol (per 10 mg/dL:
1.05 (95%CI: 1.01–1.10)), systolic blood pressure (per 10 mmHg: 1.19 (95%CI: 1.11–1.28))
and current smoking (1.49 (95%CI: 1.04–2.15)) were independent predictors of CAC onset.
The probability of CAC onset steadily increased with age from 23.3% (men) and 15.3%
(women) at age 45–49 years to 66.7% (men) and 42.9% (women) at age 70–74 years. The
difference in age-dependent conversion rates was quantified by years between reaching
a given level of CAC onset probability. We found a consistent pattern with respect
to smoking status: presently (formerly) smoking middle-aged men convert to positive
CAC 10 (5) years earlier than never smokers, for women (middle-aged to elderly) this
time span is 8 (5) years.
Conclusion
Several traditional CVD risk factors are associated with CAC onset during 5 years
follow-up. CAC onset is accelerated by approximately 10 (5) years for present (former)
compared to never smokers.
Keywords
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Article info
Publication history
Accepted:
November 15,
2013
Received in revised form:
November 14,
2013
Received:
June 24,
2013
Identification
Copyright
© 2013 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
