Comparison of Carotid Plaque Score and Coronary Artery Calcium Score for Predicting Cardiovascular Disease Events: The Multi-Ethnic Study of Atherosclerosis

J Am Heart Assoc. 2017 Feb 14;6(2):e005179. doi: 10.1161/JAHA.116.005179.

Abstract

Background: Coronary artery calcium (CAC) predicts coronary heart disease (CHD) events better than carotid wall plaque presence; however, differences in the utility of CAC burden and carotid plaque burden across the spectrum of cardiovascular disease (CVD) events is unknown.

Methods and results: CVD, CHD and stroke/transient ischemic attack (TIA) events were evaluated prospectively in a multiethnic cohort without CVD at baseline. Carotid plaque score was determined by the number of ultrasound-detected plaques in the common, bifurcation, and internal carotid artery segments. CAC was detected by computed tomography. Predictive values were compared using Cox proportional hazards models, C-statistics, and net reclassification, adjusting for traditional CVD risk factors. At baseline, the 4955 participants were mean (SD) 61.6 (10.1) years old and 52.8% female; 48.9% had CAC >0 and 50.8% had at least 1 carotid plaque. After 11.3 (3.0) years of follow-up, 709 CVD, 498 CHD, and 262 stroke/TIA events occurred. CAC score compared to carotid plaque score was a stronger predictor of CVD (hazard ratio [HR], 1.78; 95% CI, 1.16-1.98; P<0.001 vs HR, 1.27; 95% CI, 1.16-1.40; P<0.001) and CHD events (HR, 2.09; 95% CI, 1.84-2.38; P<0.001 vs HR, 1.35; 95% CI, 1.21-1.51; P<0.001). CAC score and carotid plaque score were weak predictors of stroke/TIA. CAC score had better reclassification statistics than carotid plaque score, except for stroke/TIA, which had similar predictive values.

Conclusions: CAC score improved prediction, discrimination, and reclassification of CVD and CHD better than carotid ultrasound measures, although prediction and discrimination were similar for stroke/TIA.

Keywords: atherosclerosis; cardiovascular disease; carotid artery; imaging; risk factor.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Atherosclerosis / diagnosis
  • Atherosclerosis / ethnology*
  • Atherosclerosis / etiology
  • Cardiovascular Diseases / diagnosis
  • Cardiovascular Diseases / ethnology
  • Cardiovascular Diseases / etiology
  • Carotid Artery Diseases / complications
  • Carotid Artery Diseases / diagnosis
  • Carotid Artery Diseases / ethnology*
  • Carotid Artery, Common / diagnostic imaging
  • Carotid Artery, Internal / diagnostic imaging
  • Cohort Studies
  • Coronary Angiography
  • Coronary Artery Disease / diagnosis
  • Coronary Artery Disease / ethnology*
  • Coronary Artery Disease / etiology
  • Coronary Vessels / diagnostic imaging
  • Coronary Vessels / metabolism*
  • Ethnicity*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Plaque, Atherosclerotic / complications
  • Plaque, Atherosclerotic / diagnosis
  • Plaque, Atherosclerotic / ethnology*
  • Prevalence
  • Proportional Hazards Models
  • Prospective Studies
  • Risk Assessment
  • Tomography, X-Ray Computed
  • Ultrasonography
  • United States / epidemiology
  • Vascular Calcification / complications*
  • Vascular Calcification / diagnosis
  • Vascular Calcification / metabolism