Coronary Calcium as a Predictor of Coronary Events in Four Racial or Ethnic Groups
Robert Detrano, M.D., Ph.D., Alan D. Guerci, M.D., J. Jeffrey Carr, M.D., M.S.C.E., Diane E. Bild, M.D., M.P.H., Gregory Burke, M.D., Ph.D., Aaron R. Folsom, M.D., Kiang Liu, Ph.D., Steven Shea, M.D., Moyses Szklo, M.D., Dr.P.H., David A. Bluemke, M.D., Ph.D., Daniel H. O'Leary, M.D., Russell Tracy, Ph.D., Karol Watson, M.D., Ph.D., Nathan D. Wong, Ph.D., and Richard A. Kronmal, Ph.D.
Background In white populations, computed tomographic measurementsof coronary-artery calcium predict coronary heart disease independentlyof traditional coronary risk factors. However, it is not knownwhether coronary-artery calcium predicts coronary heart diseasein other racial or ethnic groups.
Methods We collected data on risk factors and performed scanningfor coronary calcium in a population-based sample of 6722 menand women, of whom 38.6% were white, 27.6% were black, 21.9%were Hispanic, and 11.9% were Chinese. The study subjects hadno clinical cardiovascular disease at entry and were followedfor a median of 3.8 years.
Results There were 162 coronary events, of which 89 were majorevents (myocardial infarction or death from coronary heart disease).In comparison with participants with no coronary calcium, theadjusted risk of a coronary event was increased by a factorof 7.73 among participants with coronary calcium scores between101 and 300 and by a factor of 9.67 among participants withscores above 300 (P<0.001 for both comparisons). Among thefour racial and ethnic groups, a doubling of the calcium scoreincreased the risk of a major coronary event by 15 to 35% andthe risk of any coronary event by 18 to 39%. The areas underthe receiver-operating-characteristic curves for the predictionof both major coronary events and any coronary event were higherwhen the calcium score was added to the standard risk factors.
Conclusions The coronary calcium score is a strong predictorof incident coronary heart disease and provides predictive informationbeyond that provided by standard risk factors in four majorracial and ethnic groups in the United States. No major differencesamong racial and ethnic groups in the predictive value of calciumscores were detected.
Source Information
From the University of California at Irvine, Irvine (R.D., N.D.W.); Saint Francis Hospital, Roslyn, NY (A.D.G.); Wake Forest Baptist Medical Center, Winston-Salem, NC (J.J.C., G.B.); the Division of Prevention and Population Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (D.E.B.); the University of Minnesota, Minneapolis (A.R.F.); Northwestern University, Chicago (K.L.); Columbia University, New York (S.S.); Johns Hopkins University, Baltimore (M.S., D.A.B.); Caritas Carney Hospital, Dorchester, MA (D.H.O.); the University of Vermont, Burlington (R.T.); the University of California at Los Angeles, Los Angeles (K.W.); and the University of Washington, Seattle (R.A.K.).
Address reprint requests to Dr. Detrano at the Department of Radiological Sciences, University of California at Irvine, Medical Sciences Bldg., Irvine, CA 92697, or at robert{at}chinacal.org.
Coronary Calcium and Events in Four Ethnic Groups
Payne P. W. Jr., Littmann L., Burtey S., Dussol B., Brunet P., Goyal S. K., Punnam S. R., Nasir K., Budoff M. J., Blumenthal R., Guerci A. D., Bild D. E., Kronmal R. A., Weintraub W. S., Diamond G. A.
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N Engl J Med 2008;
359:202-204, Jul 10, 2008.
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