Portal de Periódicos da CAPES

Coronary Artery Calcification Compared With Carotid Intima-Media Thickness in the Prediction of Cardiovascular Disease Incidence<subtitle>The Multi-Ethnic Study of Atherosclerosis (MESA)</subtitle>

2008; American Medical Association; Volume: 168; Issue: 12 Linguagem: Inglês

10.1001/archinte.168.12.1333

1538-3679

Aaron R. Folsom, Richard A. Kronmal, Robert Detrano, Daniel H. O’Leary, Diane E. Bild, David A. Bluemke, Matthew J. Budoff, Kiang Liu, Steven M. Shea, Moysés Szklo, Russell P. Tracy, Karol E. Watson, Gregory L. Burke,

Cardiovascular Disease and Adiposity

Context-Coronary artery calcium (CAC) and carotid intima-media thickness (IMT) are noninvasive measures of atherosclerosis that consensus panels have recommended as possible additions to risk factor assessment for predicting the probability of cardiovascular disease (CVD) occurrence.Objective-To assess whether maximum carotid IMT or CAC (Agatston Score) is the better predictor of incident CVD.Design, Setting, Patients-Prospective cohort study of 45-84 year-olds initially free of CVD (n = 6,698) in four ethnic groups, with standardized carotid IMT and CAC measures at baseline, in six field centers of the Multi-Ethnic Study of Atherosclerosis (MESA).Main Outcome Measure(s)-Incident CVD events (coronary heart disease, stroke, and fatal CVD) over a maximum of 5.3 years of follow-up.Results-There were 222 CVD events during follow-up.CAC was associated more strongly than carotid IMT with risk of incident CVD.After adjustment for each other and traditional CVD risk factors, the hazard of CVD increased 2.1-fold (95% CI 1.8-2.5)for each standard deviation greater level of log-transformed CAC, versus 1.3-fold (95% CI 1.1-1.4)for each standard deviation greater maximum IMT.For coronary heart disease, the hazard ratios per standard deviation increment were 2.5-fold (95% CI 2.1-3.1) for CAC and 1.2-fold (95% CI 1.0-1.4)for IMT.An ROC analysis also suggested that CAC predicted incident CVD better than IMT did.Conclusions-Although whether and how to clinically use bio-imaging tests of subclinical atherosclerosis remains a topic of debate, this study found that CAC predicts subsequent CVD events better than does carotid IMT.