Razavi Alexander C, Dzaye Omar, Cainzos-Achirica Miguel, Dardari Zeina, Van Assen Marly, Quyyumi Arshed A, Nasir Khurram, Carr J Jeffrey, Budoff Matthew J, Blumenthal Roger S, Raggi Paolo, De Cecco Carlo N, Sperling Laurence S, Blaha Michael J, Whelton Seamus P
Center for Heart Disease Prevention, Emory University School of Medicine, Atlanta, GA, United States.
Translational Laboratory for Cardiothoracic Imaging and Artificial Intelligence, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States.
Am J Prev Cardiol. 2025 Jan 2;21:100916. doi: 10.1016/j.ajpc.2024.100916. eCollection 2025 Mar.
Calcification of the ascending and/or descending thoracic aorta is easily measured via non-contrast cardiac computed tomography (CT), commonly performed for quantification of coronary artery calcium (CAC). We assessed whether thoracic aortic calcium (TAC) further improves long-term cardiovascular disease (CVD) risk stratification beyond CAC alone.
Cardiac CT was performed among 6,783 asymptomatic Multi-Ethnic Study of Atherosclerosis participants at baseline. Cox proportional hazards regression assessed the association of TAC with incident CVD and all-cause mortality over a median follow-up of 17.7 years, adjusting for CVD risk factors and CAC.
The mean age was 62.1 years old, 53% were female, and 28% had TAC. Over a median follow-up of 17.7 years, 48% of participants with TAC ≥500 experienced CVD and 72% died. Compared to TAC=0, TAC ≥500 was significantly associated with an increased risk of CVD (HR=1.28, 95% CI: 1.06-1.54) and all-cause mortality (HR=1.44, 95% CI: 1.25-1.65), with the strongest association among persons with CAC=0 (CVD HR=1.79, 95% CI: 1.04-3.07; all-cause mortality HR=1.82, 95% CI: 1.29-2.56). The addition of TAC to traditional risk factors and CAC did not improve CVD discrimination (ΔC-statistic=+0.002, =0.12), but incrementally improved prediction of all-cause mortality (CVD: ΔC-statistic=+0.002, =0.02).
Participants with TAC ≥500 had a high long-term risk for CVD and all-cause mortality. TAC primarily improved risk stratification among persons with CAC=0.
升主动脉和/或降主动脉钙化可通过非增强心脏计算机断层扫描（CT）轻松测量，这种扫描常用于冠状动脉钙化（CAC）的量化。我们评估了胸主动脉钙化（TAC）是否能在单独的CAC基础上进一步改善长期心血管疾病（CVD）风险分层。
对6783名无症状的动脉粥样硬化多民族研究参与者在基线时进行心脏CT检查。Cox比例风险回归评估了TAC与中位随访17.7年期间发生的CVD和全因死亡率之间的关联，并对CVD风险因素和CAC进行了调整。
平均年龄为62.1岁，53%为女性，28%有TAC。在中位随访17.7年期间，TAC≥500的参与者中有48%发生了CVD，72%死亡。与TAC = 0相比，TAC≥500与CVD风险增加（HR = 1.28，95% CI：1.06 - 1.54）和全因死亡率增加（HR = 1.44，95% CI：1.25 - 1.65）显著相关，在CAC = 0的人群中关联最强（CVD HR = 1.79，95% CI：1.04 - 3.07；全因死亡率HR = 1.82，95% CI：1.29 - 2.56）。将TAC添加到传统风险因素和CAC中并没有改善CVD的辨别能力（ΔC统计量 = +0.002，P = 0.12），但逐步改善了全因死亡率的预测（CVD：ΔC统计量 = +0.002，P = 0.02）。
TAC≥500的参与者有较高的长期CVD和全因死亡率风险。TAC主要改善了CAC = 0人群的风险分层。
