Advertisement

Relation of Thoracic Aortic and Coronary Artery Calcium to Cardiovascular Risk Factors (from The Brazilian Longitudinal Study of Adult Health [ELSA-Brazil])

Published:September 06, 2019DOI:https://doi.org/10.1016/j.amjcard.2019.08.029
      Thoracic aortic calcium (TAC) and coronary artery calcium (CAC) are associated with an increased risk of cardiovascular disease (CVD) and death. However, risk factors associated with arterial calcium may vary across vascular beds. We verified whether TAC is associated with the same risk factors as is CAC in adults without established CVD. Cross-sectional analysis including 2,433 participants (aged 38 to 78 years) of ELSA-Brasil cohort in Minas Gerais, Brazil. Nonenhanced ECG-gated multislice computed tomography were performed to detect calcium in the thoracic aorta and the coronaries (2015 to 2016). Multivariate logistic regression evaluated the associations of both TAC and CAC with CVD risk factors (smoking, body mass index, physical activity, alcohol intake, family history of CVD, low-density lipoprotein- and high-density lipoprotein-cholesterol, HbA1c, blood pressure, antidiabetic, antihypertensive, and lipid lowering medications). Overall prevalence of TAC and CAC were 69% and 43%, respectively. CAC prevalence was lower among women (31%) than men (56%) (Adjusted odds ratio [OR] 0.30; 0.24 to 0.38). After adjustments, black individuals were less likely to have any CAC as compared with whites (OR 0.63; 0.47 to 0.86). Neither sex, nor race/skin color were statistically associated with TAC. Use of antidiabetic medications remained associated with CAC (OR 1.80; 1.23 to 2.631.01), but not with TAC. All other risk factors, except education, alcohol, physical activity and HbA1c, persisted statistically associated with both TAC and CAC in the final analysis, with small differences in the magnitudes of the ORs. In conclusion, the only disagreements seen in the risk factors associated with CAC and TAC were sex, race/skin color, and use of antidiabetic medications.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Budoff MJ
        • Nasir K
        • Katz R
        • Takasu J
        • Carr JJ
        • Wong ND
        • Allison M
        • Lima JAC
        • Detrano R
        • Blumenthal RS
        • Kronmal R
        Thoracic aortic calcification and coronary heart disease events: the multi-ethnic study of atherosclerosis (MESA).
        Atherosclerosis. 2011; 215: 196-202
        • Kälsch H
        • Lehmann N
        • Moebus S
        • Hoffmann B
        • Stang A
        • Jöckel K
        • Erbel R
        • Mahabadi AA
        Aortic calcification onset and progression: association with the development of coronary atherosclerosis.
        J Am Heart Assoc. 2017; 6 (Available at:): 1-12
        • Allison MA
        • Hsi S
        • Wassel CL
        • Morgan C
        • Ix JH
        • Wright CM
        • Criqui MH
        Calcified atherosclerosis in different vascular beds and the risk of mortality.
        Arterioscler Thromb Vasc Biol. 2012; 32: 140-146
        • Aquino EML
        • Barreto SM
        • Bensenor IM
        • Carvalho MS
        • Chor D
        • Duncan BB
        • Lotufo PA
        • Mill JG
        • Molina MDC
        • Mota ELA
        • Azeredo Passos VM
        • Schmidt MI
        • Szklo M
        Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): objectives and design.
        Am J Epidemiol. 2012; 175 (Available at:): 315-324
        • Schmidt MI
        • Duncan BB
        • Mill JG
        • Lotufo PA
        • Chor D
        • Barreto SM
        • Aquino EML
        • Passos VMA
        • Matos SMA
        • Molina M
        • del CB
        • Carvalho MS
        • Bensenor IM
        Cohort profile: longitudinal study of adult health (ELSA-Brasil).
        Int J Epidemiol. 2015; 44: 68-75
        • Camelo LD V.
        • Giatti L
        • Barreto SM
        Subjective social status, self-rated health and tobacco smoking: Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).
        J Health Psychol. 2014; 19 (Available at:): 1388-1399
        • Craig CL
        • Marshall AL
        • Sjöström M
        • Bauman AE
        • Booth ML
        • Ainsworth BE
        • Pratt M
        • Ekelund U
        • Yngve A
        • Sallis JF
        • Oja P
        International physical activity questionnaire: 12-country reliability and validity.
        Med Sci Sports Exerc. 2003; 35: 1381-1395
        • Brant LCC
        • Hamburg NM
        • Barreto SM
        • Benjamin EJ
        • Ribeiro ALP
        Relations of digital vascular function, cardiovascular risk factors, and arterial stiffness: the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort study.
        J Am Heart Assoc. 2014; 3: 1-11
        • Chor D
        • Alves MG de M
        • Giatti L
        • Cade NV
        • Nunes MA
        • Molina M del CB
        • Bensenor IM
        • Aquino EML
        • Passos V
        • Santos SM
        • Fonseca M de JM da
        • Oliveira LC de
        Questionario do ELSA-Brasil: desafios na elaboracao de instrumento multidimensional.
        Rev Saude Publica. 2013; 47 (Available at:) (Accessed July 31, 2019): 27-36
        • Agatston AS
        • Janowitz FWR
        • Hildner FJ
        • Zusmer NR
        • Viamonte M
        • Detrano R
        Quantification of coronary artery calcium using ultrafast computed tomography.
        JACC. 1990; 15: 827-832
        • Craiem D
        • Chironi G
        • Casciaro ME
        • Graf S
        • Simon A
        Calcifications of the thoracic aorta on extended non-contrast-enhanced cardiac CT.
        PLoS One. 2014; 9 (Available at:)e109584
        • Jacobs PC
        • Prokop M
        • Graaf Y van der
        • Gondrie MJ
        • Janssen KJ
        • Koning HJ de
        • Isgum I
        • Klaveren RJ van
        • Oudkerk M
        • Ginneken B van
        • Mali WP
        Comparing coronary artery calcium and thoracic aorta calcium for prediction of all-cause mortality and cardiovascular events on low-dose non-gated computed tomography in a high-risk population of heavy smokers.
        Atherosclerosis. 2010; 209 (Available at:): 455-462
        • Kälsch H
        • Lehmann N
        • Möhlenkamp S
        • Hammer C
        • Mahabadi AA
        • Moebus S
        • Schmermund A
        • Stang A
        • Bauer M
        • Jöckel KH
        • Erbel R
        Prevalence of thoracic aortic calcification and its relationship to cardiovascular risk factors and coronary calcification in an unselected population-based cohort: the Heinz Nixdorf Recall Study.
        Int J Cardiovasc Imaging. 2013; 29: 207-216
        • McClelland RL
        • Chung H
        • Detrano R
        • Post W
        • Kronmal RA
        Distribution of coronary artery calcium by race, gender, and age.
        Circulation. 2006; 113: 30-37
        • Pereira AC
        • Gomez LM
        • Bittencourt MS
        • Staniak HL
        • Sharovsky R
        • Foppa M
        • Blaha MJ
        • Bensenor IM
        • Lotufo PA
        Age, gender, and race-based coronary artery calcium score percentiles in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).
        Clin Cardiol. 2016; 39: 352-359
        • Nasir K
        • Roguin A
        • Sarwar A
        • Rumberger J a.
        • Blumenthal RS
        Gender differences in coronary arteries and thoracic aorta calcification.
        Arterioscler Thromb Vasc Biol. 2007; 27: 1220-1222
        • Wu M
        • Chern M
        • Chen L
        • Lin Y
        • Sheu M
        Electron beam computed tomography evidence of aortic calcification as an independent determinant of coronary artery calcification.
        J Chinese Med Assoc. 2006; 69 (Available at:): 409-414
        • Odink AE
        • Lugt A van der
        • Hofman A
        • Hunink MGM
        • Breteler MMB
        • Krestin GP
        • Witteman JCM
        Association between calcification in the coronary arteries, aortic arch and carotid arteries: the Rotterdam study.
        Atherosclerosis. 2007; 193: 408-413
        • Bild DE
        • Detrano R
        • Peterson D
        • Guerci A
        • Liu K
        • Shahar E
        • Ouyang P
        • Jackson S
        • Saad MF
        Ethnic differences in coronary calcification: the Multi-Ethnic Study of Atherosclerosis (MESA).
        Circulation. 2005; 111: 1313-1320
        • Allison MA
        • Budoff MJ
        • Nasir K
        • Wong ND
        • Detrano R
        • Kronmal R
        • Takasu J
        • Criqui MH
        Ethnic-Specific Risks for Atherosclerotic Calcification of the Thoracic and Abdominal Aorta (from the Multi-Ethnic Study of Atherosclerosis).
        Am J Cardiol. 2009; 104 (Available at:): 812-817
        • Takasu J
        • Katz R
        • Nasir K
        • Carr JJ
        • Wong N
        • Detrano R
        • Budoff MJ
        Relationships of thoracic aortic wall calcification to cardiovascular risk factors: the Multi-Ethnic Study of Atherosclerosis (MESA).
        Am Heart J. 2008; 155 (Available at:) (Accessed August 15, 2019): 765-771
        • Cardena MMSG
        • Ribeiro-dos-Santos Â
        • Santos S
        • Mansur AJ
        • Pereira AC
        • Fridman C
        Assessment of the relationship between self-declared ethnicity, mitochondrial haplogroups and genomic ancestry in Brazilian individuals.
        PLoS One. 2013; 8 (Available at:): e62005
        • Giolo SR
        • Soler JMP
        • Greenway SC
        • Almeida MAA
        • Andrade M De
        • Seidman JG
        • Seidman CE
        • Krieger JE
        • Pereira AC
        Brazilian urban population genetic structure reveals a high degree of admixture.
        Eur J Hum Genet. 2012; 20: 111-116
        • Ong KL
        • McClelland RL
        • Rye KA
        • Cheung BMY
        • Post WS
        • Vaidya D
        • Criqui MH
        • Cushman M
        • Barter PJ
        • Allison MA
        The relationship between insulin resistance and vascular calcification in coronary arteries, and the thoracic and abdominal aorta: the multi-ethnic study of atherosclerosis.
        Atherosclerosis. 2014; 236 (Available at:): 257-262
        • Tsai JP
        • Kuo R
        • Sun JY
        • Yun CH
        • Sung KT
        • Liu CC
        • Kuo JY
        • Hung CL
        • Wu TH
        • Lin JL
        • Hung TC
        • Liu CY
        • Hou CJY
        • Yeh HI
        • Bezerra HG
        Correction: thoracic aortic calcification across the clinical dysglycemic continuum in a large Asian population free of cardiovascular symptoms (PLoS ONE (2019) 14: 1 (e0207089) DOI: 10.1371/journal.pone.0207089).
        PLoS One. 2019; 14: 1-13
        • Zhu D
        • Mackenzie NCW
        • Farquharson C
        • MacRae VE
        Mechanisms and clinical consequences of vascular calcification.
        Front Endocrinol (Lausanne). 2012; 3 (Available at:): 1-12
        • Doherty TM
        • Fitzpatrick LA
        • Shaheen A
        • Rajavashisth TB
        • Detrano RC
        Genetic determinants of arterial calcification associated with atherosclerosis.
        Mayo Clin Proc. 2004; 79: 197-210
        • Abramowitz Y
        • Jilaihawi H
        • Chakravarty T
        • Mack MJ
        • Makkar RR
        Porcelain aorta: a comprehensive review.
        Circulation. 2015; 131: 827-836
        • Thomas IC
        • Thompson CA
        • Yang M
        • Allison MA
        • Forbang NI
        • Michos ED
        • McClelland RL
        • Budoff MJ
        • Criqui MH
        Thoracic aorta calcification and noncardiovascular disease-related mortality the multi-ethnic study of atherosclerosis.
        Arterioscler Thromb Vasc Biol. 2018; 38: 1926-1932