Dataset Information

Relation of Diastolic Blood Pressure and Coronary Artery Calcium to Coronary Events and Outcomes (From the Multi-Ethnic Study of Atherosclerosis).

ABSTRACT: Diastolic blood pressure has a J-curve relation with coronary heart disease and death. Because this association is thought to reflect reduced coronary perfusion at low diastolic blood pressure, we hypothesized that the J-curve would be most pronounced in persons with coronary artery calcium. In 6,811 participants from the Multi-Ethnic Study of Atherosclerosis, we used Cox models to examine if diastolic blood pressure category is associated with coronary heart disease events, stroke, and mortality. Analyses were conducted in the sample overall and after stratification by coronary artery calcium score. In multivariable-adjusted analyses, compared with diastolic blood pressure of 80 to 89?mm Hg (reference), persons with diastolic blood pressure <60?mm Hg had increased risk of coronary heart disease events (hazard ratio 1.69 [95% confidence interval 1.02 to 2.79]) and all-cause mortality (hazard ratio 1.48 [95% confidence interval 1.10 to 2.00]), but not stroke. After stratification, associations of diastolic blood pressure <60?mm Hg with events were present only in participants with coronary artery calcium >0. Diastolic blood pressure <60?mm Hg was not associated with events when coronary artery calcium was zero. However, the association between diastolic blood pressure and events did not demonstrate statistical interaction when stratified by presence or absence of coronary calcium. We also found no interaction in the association between low diastolic blood pressure and events based on race. In conclusion, diastolic blood pressure <60?mm Hg was associated with increased risk of coronary heart disease events and all-cause mortality in the sample overall, but this association appeared strongest in individuals with subclinical atherosclerosis.

SUBMITTER: Rahman F

PROVIDER: S-EPMC5654652 | biostudies-literature | 2017 Nov

REPOSITORIES: biostudies-literature

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Relation of Diastolic Blood Pressure and Coronary Artery Calcium to Coronary Events and Outcomes (From the Multi-Ethnic Study of Atherosclerosis).

Rahman Faisal F Al Rifai Mahmoud M Blaha Michael J MJ Nasir Khurram K Budoff Matthew J MJ Psaty Bruce M BM Post Wendy S WS Blumenthal Roger S RS McEvoy John W JW

The American journal of cardiology 20170808 10

Diastolic blood pressure has a J-curve relation with coronary heart disease and death. Because this association is thought to reflect reduced coronary perfusion at low diastolic blood pressure, we hypothesized that the J-curve would be most pronounced in persons with coronary artery calcium. In 6,811 participants from the Multi-Ethnic Study of Atherosclerosis, we used Cox models to examine if diastolic blood pressure category is associated with coronary heart disease events, stroke, and mortalit ...[more]

PMID: 28864316

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Project description:BackgroundThe 2018 American Heart Association/American College of Cardiology/Multisociety cholesterol guideline states that statin therapy may be withheld or delayed among intermediate-risk individuals in the absence of coronary artery calcium (CAC=0). We evaluated whether traditional cardiovascular risk factors are associated with incident atherosclerotic cardiovascular disease (ASCVD) events among individuals with CAC=0 over long-term follow-up.MethodsWe included participants with CAC=0 at baseline from the MESA (Multi-Ethnic Study of Atherosclerosis), a prospective cohort study of individuals free of clinical ASCVD at baseline. We used multivariable-adjusted Cox proportional hazards models to study the association between cardiovascular risk factors (cigarette smoking, diabetes, hypertension, preventive medication use [aspirin and statin], family history of premature ASCVD, chronic kidney disease, waist circumference, lipid and inflammatory markers) and adjudicated incident ASCVD outcomes.ResultsWe studied 3416 individuals (mean [SD] age 58 [9] years; 63% were female, 33% White, 31% Black, 12% Chinese American, and 24% Hispanic). Over a median follow-up of 16 years, there were 189 ASCVD events (composite of coronary heart disease and stroke) of which 91 were coronary heart disease, 88 were stroke, and 10 were both coronary heart disease and stroke events. The unadjusted event rates of ASCVD were ≤5 per 1000 person-years among individuals with CAC=0 for most risk factors with the exception of current cigarette smoking (7.3), diabetes (8.9), hypertension (5.4), and chronic kidney disease (6.8). After multivariable adjustment, risk factors that were significantly associated with ASCVD included current cigarette smoking: hazard ratio, 2.12 (95% CI, 1.32-3.42); diabetes: hazard ratio, 1.68 (95% CI, 1.01-2.80); and hypertension: hazard ratio, 1.57 (95% CI, 1.06-2.33).ConclusionsCurrent cigarette smoking, diabetes, and hypertension are independently associated with incident ASCVD over a 16-year follow-up among those with CAC=0.

Project description:AimsWhile coronary artery calcium (CAC) has been extensively validated for predicting clinical events, most outcome studies of CAC have evaluated coronary heart disease (CHD) rather than atherosclerotic cardiovascular disease (ASCVD) events (including stroke). Also, virtually all CAC studies are of short- or intermediate-term follow-up, so studies across multi-ethnic cohorts with long-term follow-up are warranted prior to widespread clinical use. We sought to evaluate the contribution of CAC using the population-based MESA cohort with over 10 years of follow-up for ASCVD events, and whether the association of CAC with events varied by sex, race/ethnicity, or age category.Methods and resultsWe utilized MESA, a prospective multi-ethnic cohort study of 6814 participants (51% women), aged 45-84 years, free of clinical CVD at baseline. We evaluated the relationship between CAC and incident ASCVD using Cox regression models adjusted for age, race/ethnicity, sex, education, income, cigarette smoking status, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, diabetes, lipid-lowering medication, systolic blood pressure, antihypertensive medication, intentional physical exercise, and body mass index. Only the first event for each individual was used in the analysis. Overall, 500 incident ASCVD (7.4%) events were observed in the total study population over a median of 11.1 years. Hard ASCVD included 217 myocardial infarction, 188 strokes (not transient ischaemic attack), 13 resuscitated cardiac arrest, and 82 CHD deaths. Event rates in those with CAC = 0 Agatston units ranged from 1.3% to 5.6%, while for those with CAC > 300, the 10-year event rates ranged from 13.1% to 25.6% across different age, gender, and racial subgroups. At 10 years of follow-up, all participants with CAC > 100 were estimated to have >7.5% risk regardless of demographic subset. Ten-year ASCVD event rates increased steadily across CAC categories regardless of age, sex, or race/ethnicity. For each doubling of CAC, we estimated a 14% relative increment in ASCVD risk, holding all other risk factors constant. This association was not significantly modified by age, sex, race/ethnicity, or baseline lipid-lowering use.ConclusionsCoronary artery calcium is associated strongly and in a graded fashion with 10-year risk of incident ASCVD as it is for CHD, independent of standard risk factors, and similarly by age, gender, and ethnicity. While 10-year event rates in those with CAC = 0 were almost exclusively below 5%, those with CAC ≥ 100 were consistently above 7.5%, making these potentially valuable cutpoints for the consideration of preventive therapies. Coronary artery calcium strongly predicts risk with the same magnitude of effect in all races, age groups, and both sexes, which makes it among the most useful markers for predicting ASCVD risk.

Project description:This study sought to determine if coronary artery calcium (CAC) is associated with incident noncardiovascular disease.CAC is considered a measure of vascular aging, associated with increased risk of cardiovascular and all-cause mortality. The relationship with noncardiovascular disease is not well defined.A total of 6,814 participants from 6 MESA (Multi-Ethnic Study of Atherosclerosis) field centers were followed for a median of 10.2 years. Modified Cox proportional hazards ratios accounting for the competing risk of fatal coronary heart disease were calculated for new diagnoses of cancer, pneumonia, chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), deep vein thrombosis/pulmonary embolism, hip fracture, and dementia. Analyses were adjusted for age; sex; race; socioeconomic status; health insurance status; body mass index; physical activity; diet; tobacco use; number of medications used; systolic and diastolic blood pressure; total and high-density lipoprotein cholesterol; antihypertensive, aspirin, and cholesterol medication; and diabetes. The outcome was first incident noncardiovascular disease diagnosis.Compared with those with CAC = 0, those with CAC >400 had an increased hazard of cancer (hazard ratio [HR]: 1.53; 95% confidence interval [CI]: 1.18 to 1.99), CKD (HR: 1.70; 95% CI: 1.21 to 2.39), pneumonia (HR: 1.97; 95% CI: 1.37 to 2.82), COPD (HR: 2.71; 95% CI: 1.60 to 4.57), and hip fracture (HR: 4.29; 95% CI: 1.47 to 12.50). CAC >400 was not associated with dementia or deep vein thrombosis/pulmonary embolism. Those with CAC = 0 had decreased risk of cancer (HR: 0.76; 95% CI: 0.63 to 0.92), CKD (HR: 0.77; 95% CI: 0.60 to 0.98), COPD (HR: 0.61; 95% CI: 0.40 to 0.91), and hip fracture (HR: 0.31; 95% CI: 0.14 to 0.70) compared to those with CAC >0. CAC = 0 was not associated with less pneumonia, dementia, or deep vein thrombosis/pulmonary embolism. The results were attenuated, but remained significant, after removing participants developing interim nonfatal coronary heart disease.Participants with elevated CAC were at increased risk of cancer, CKD, COPD, and hip fractures. Those with CAC = 0 are less likely to develop common age-related comorbid conditions, and represent a unique population of "healthy agers."

Dataset Information

Relation of Diastolic Blood Pressure and Coronary Artery Calcium to Coronary Events and Outcomes (From the Multi-Ethnic Study of Atherosclerosis).

Publications

Relation of Diastolic Blood Pressure and Coronary Artery Calcium to Coronary Events and Outcomes (From the Multi-Ethnic Study of Atherosclerosis).

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