Age, Gender, and Race-Based Coronary Artery Calcium Score Percentiles in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Clin Cardiol. 2016 Jun;39(6):352-9. doi: 10.1002/clc.22539. Epub 2016 Apr 15.


Background: Coronary artery calcium (CAC) has been demonstrated to independently predict the risk of cardiovascular events and all-cause mortality, especially among White populations. Although the population distribution of CAC has been determined for several White populations, the distribution in ethnically admixed groups has not been well established.

Hypothesis: The CAC distribution, stratified for age, gender and race, is similar to the previously described distribution in the MESA study.

Methods: The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is a prospective cohort study designed to investigate subclinical cardiovascular disease in 6 different centers of Brazil. Similar to previous studies, individuals with self-reported coronary or cerebrovascular disease and those treated for diabetes mellitus were excluded from analysis.

Results: Percentiles of CAC distribution were estimated with nonparametric techniques. The analysis included 3616 individuals (54% female; mean age, 50 years). As expected, CAC prevalence and burden were steadily higher with increasing age, as well as increased in men and in White individuals. Our results revealed that for a given CAC score, the ELSA-derived CAC percentile would be lower in men compared with the Multi-Ethnic Study of Atherosclerosis (MESA) and would be higher in women compared with MESA.

Conclusions: In our sample of the Brazilian population, we observed significant differences in CAC by sex, age, and race. Adjusted for age and sex, low-risk individuals from the Brazilian population present with significantly lower CAC prevalence and burden compared with other low-risk individuals from other worldwide populations. Using US-derived percentiles in Brazilian individuals may lead to overestimating relative CAC burden in men and underestimating relative CAC burden in women.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Adult
  • Age Distribution
  • Aged
  • Brazil / epidemiology
  • Computed Tomography Angiography
  • Coronary Angiography / methods
  • Coronary Artery Disease / diagnostic imaging
  • Coronary Artery Disease / ethnology*
  • Female
  • Health Surveys
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Prevalence
  • Prognosis
  • Prospective Studies
  • Racial Groups*
  • Risk Factors
  • Sex Distribution
  • Time Factors
  • Vascular Calcification / diagnostic imaging
  • Vascular Calcification / ethnology*