FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 358:1336-1345 March 27, 2008 Number 13 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set CME Exam Editorial by Weintraub, W. S. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background In white populations, computed tomographic measurements of coronary-artery calcium predict coronary heart disease independently of traditional coronary risk factors. However, it is not known whether coronary-artery calcium predicts coronary heart disease in other racial or ethnic groups.

Methods We collected data on risk factors and performed scanning for coronary calcium in a population-based sample of 6722 men and women, of whom 38.6% were white, 27.6% were black, 21.9% were Hispanic, and 11.9% were Chinese. The study subjects had no clinical cardiovascular disease at entry and were followed for a median of 3.8 years.

Results There were 162 coronary events, of which 89 were major events (myocardial infarction or death from coronary heart disease). In comparison with participants with no coronary calcium, the adjusted risk of a coronary event was increased by a factor of 7.73 among participants with coronary calcium scores between 101 and 300 and by a factor of 9.67 among participants with scores above 300 (P<0.001 for both comparisons). Among the four racial and ethnic groups, a doubling of the calcium score increased the risk of a major coronary event by 15 to 35% and the risk of any coronary event by 18 to 39%. The areas under the receiver-operating-characteristic curves for the prediction of both major coronary events and any coronary event were higher when the calcium score was added to the standard risk factors.

Conclusions The coronary calcium score is a strong predictor of incident coronary heart disease and provides predictive information beyond that provided by standard risk factors in four major racial and ethnic groups in the United States. No major differences among racial and ethnic groups in the predictive value of calcium scores 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.

Full Text of this Article

Related Letters:

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.
Extract | Full Text | PDF  
N Engl J Med 2008; 359:202-204, Jul 10, 2008. Correspondence

This article has been cited by other articles:

• Parker, B. D., Ix, J. H., Cranenburg, E. C. M., Vermeer, C., Whooley, M. A., Schurgers, L. J. (2009). Association of kidney function and uncarboxylated matrix Gla protein: Data from the Heart and Soul Study. Nephrol Dial Transplant 24: 2095-2101 [Abstract] [Full Text]  
• van Werkhoven, J. M., Schuijf, J. D., Gaemperli, O., Jukema, J. W., Kroft, L. J., Boersma, E., Pazhenkottil, A., Valenta, I., Pundziute, G., de Roos, A., van der Wall, E. E., Kaufmann, P. A., Bax, J. J. (2009). Incremental prognostic value of multi-slice computed tomography coronary angiography over coronary artery calcium scoring in patients with suspected coronary artery disease. Eur Heart J 0: ehp272v1-ehp272 [Abstract] [Full Text]  
• Sarwar, A., Shaw, L. J., Shapiro, M. D., Blankstein, R., Hoffman, U., Cury, R. C., Abbara, S., Brady, T. J., Budoff, M. J., Blumenthal, R. S., Nasir, K. (2009). Diagnostic and Prognostic Value of Absence of Coronary Artery Calcification. J Am Coll Cardiol Img 2: 675-688 [Abstract] [Full Text]  
• Garcia, M. J., Fuster, V. (2009). An Ounce of Prevention With a Calcium Score Scan?. J Am Coll Cardiol Img 2: 689-691 [Full Text]  
• Blaha, M., Budoff, M. J., Shaw, L. J., Khosa, F., Rumberger, J. A., Berman, D., Callister, T., Raggi, P., Blumenthal, R. S., Nasir, K. (2009). Absence of Coronary Artery Calcification and All-Cause Mortality. J Am Coll Cardiol Img 2: 692-700 [Abstract] [Full Text]  
• Achenbach, S., Dilsizian, V., Kramer, C. M., Zoghbi, W. A. (2009). The Year in Coronary Artery Disease. J Am Coll Cardiol Img 2: 774-786 [Abstract] [Full Text]  
• Shea, M K., O'Donnell, C. J, Hoffmann, U., Dallal, G. E, Dawson-Hughes, B., Ordovas, J. M, Price, P. A, Williamson, M. K, Booth, S. L (2009). Vitamin K supplementation and progression of coronary artery calcium in older men and women. Am. J. Clin. Nutr. 89: 1799-1807 [Abstract] [Full Text]  
• Shantouf, R., Kovesdy, C. P., Kim, Y., Ahmadi, N., Luna, A., Luna, C., Rambod, M., Nissenson, A. R., Budoff, M. J., Kalantar-Zadeh, K. (2009). Association of Serum Alkaline Phosphatase with Coronary Artery Calcification in Maintenance Hemodialysis Patients. CJASN 4: 1106-1114 [Abstract] [Full Text]  
• Schwartz, M. K, Lieske, J. C, Hunter, L. W., Miller, V. M (2009). Systemic injection of planktonic forms of mammalian-derived nanoparticles alters arterial response to injury in rabbits. Am. J. Physiol. Heart Circ. Physiol. 296: H1434-H1441 [Abstract] [Full Text]  
• Hlatky, M. A., Heidenreich, P. A. (2009). The Year in Epidemiology, Health Services Research, and Outcomes Research. J Am Coll Cardiol 53: 1459-1466 [Full Text]  
• Sanz, J., Moreno, P. R., Fuster, V. (2009). The year in atherothrombosis.. J Am Coll Cardiol 53: 1326-1337 [Full Text]  
• Shaw, L., Narula, J. (2009). Bridging the Detection Gap Chasm of Risk: Where Can Computed Tomography Angiography Take Us?. J Am Coll Cardiol Img 2: 524-526 [Full Text]  
• Wong, N. D., Gransar, H., Shaw, L., Polk, D., Moon, J. H., Miranda-Peats, R., Hayes, S. W., Thomson, L. E.J., Rozanski, A., Friedman, J. D., Berman, D. S. (2009). Thoracic aortic calcium versus coronary artery calcium for the prediction of coronary heart disease and cardiovascular disease events.. J Am Coll Cardiol Img 2: 319-326 [Abstract] [Full Text]  
• Kaul, P., Douglas, P. S. (2009). Atherosclerosis Imaging: Prognostically Useful or Merely More of What We Know?. Circ Cardiovasc Imaging 2: 150-160 [Full Text]  
• Lester, S. J., Eleid, M. F., Khandheria, B. K., Hurst, R. T. (2009). Carotid Intima-Media Thickness and Coronary Artery Calcium Score as Indications of Subclinical Atherosclerosis. Mayo Clin Proc. 84: 229-233 [Abstract] [Full Text]  
• van Werkhoven, J. M., Schuijf, J. D., Gaemperli, O., Jukema, J. W., Boersma, E., Wijns, W., Stolzmann, P., Alkadhi, H., Valenta, I., Stokkel, M. P.M., Kroft, L. J., de Roos, A., Pundziute, G., Scholte, A., van der Wall, E. E., Kaufmann, P. A., Bax, J. J. (2009). Prognostic value of multislice computed tomography and gated single-photon emission computed tomography in patients with suspected coronary artery disease.. J Am Coll Cardiol 53: 623-632 [Abstract] [Full Text]  
• Udelsman, R., Pasieka, J. L., Sturgeon, C., Young, J. E. M., Clark, O. H. (2009). Surgery for Asymptomatic Primary Hyperparathyroidism: Proceedings of the Third International Workshop. J. Clin. Endocrinol. Metab. 94: 366-372 [Abstract] [Full Text]  
• Carrigan, T. P., Nair, D., Schoenhagen, P., Curtin, R. J., Popovic, Z. B., Halliburton, S., Kuzmiak, S., White, R. D., Flamm, S. D., Desai, M. Y. (2009). Prognostic utility of 64-slice computed tomography in patients with suspected but no documented coronary artery disease. Eur Heart J 30: 362-371 [Abstract] [Full Text]  
• Foley, R. N., Collins, A. J., Herzog, C. A., Ishani, A., Kalra, P. A. (2009). Serum Phosphorus Levels Associate with Coronary Atherosclerosis in Young Adults. J. Am. Soc. Nephrol. 20: 397-404 [Abstract] [Full Text]  
• Lewis, T. T., Everson-Rose, S. A., Colvin, A., Matthews, K., Bromberger, J. T., Sutton-Tyrrell, K. (2009). Interactive Effects of Race and Depressive Symptoms on Calcification in African American and White Women. Psychosom. Med. 71: 163-170 [Abstract] [Full Text]  
• Budoff, M. J., Nasir, K., McClelland, R. L., Detrano, R., Wong, N., Blumenthal, R. S., Kondos, G., Kronmal, R. A. (2009). Coronary Calcium Predicts Events Better With Absolute Calcium Scores Than Age-Sex-Race/Ethnicity Percentiles MESA (Multi-Ethnic Study of Atherosclerosis).. J Am Coll Cardiol 53: 345-352 [Abstract] [Full Text]  
• WRITING GROUP MEMBERS, , Lloyd-Jones, D., Adams, R., Carnethon, M., De Simone, G., Ferguson, T. B., Flegal, K., Ford, E., Furie, K., Go, A., Greenlund, K., Haase, N., Hailpern, S., Ho, M., Howard, V., Kissela, B., Kittner, S., Lackland, D., Lisabeth, L., Marelli, A., McDermott, M., Meigs, J., Mozaffarian, D., Nichol, G., O'Donnell, C., Roger, V., Rosamond, W., Sacco, R., Sorlie, P., Stafford, R., Steinberger, J., Thom, T., Wasserthiel-Smoller, S., Wong, N., Wylie-Rosett, J., Hong, Y., for the American Heart Association Statistics Comm, (2009). Heart Disease and Stroke Statistics--2009 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 119: e21-e181 [Full Text]  
• Gibbons, R. J., Araoz, P. A., Williamson, E. E. (2009). The year in cardiac imaging.. J Am Coll Cardiol 53: 54-70 [Full Text]  
• King, C. R., Knutson, K. L., Rathouz, P. J., Sidney, S., Liu, K., Lauderdale, D. S. (2008). Short Sleep Duration and Incident Coronary Artery Calcification. JAMA 300: 2859-2866 [Abstract] [Full Text]  
• Ueshima, H., Sekikawa, A., Miura, K., Turin, T. C., Takashima, N., Kita, Y., Watanabe, M., Kadota, A., Okuda, N., Kadowaki, T., Nakamura, Y., Okamura, T. (2008). Cardiovascular Disease and Risk Factors in Asia: A Selected Review. Circulation 118: 2702-2709 [Full Text]  
• Pollin, T. I., Damcott, C. M., Shen, H., Ott, S. H., Shelton, J., Horenstein, R. B., Post, W., McLenithan, J. C., Bielak, L. F., Peyser, P. A., Mitchell, B. D., Miller, M., O'Connell, J. R., Shuldiner, A. R. (2008). A Null Mutation in Human APOC3 Confers a Favorable Plasma Lipid Profile and Apparent Cardioprotection. Science 322: 1702-1705 [Abstract] [Full Text]  
• Wilson, P. W.F. (2008). Progressing From Risk Factors to Omics. Circ Cardiovasc Genet 1: 141-146 [Full Text]  
• Authors/Task Force Members, , Van de Werf, F., Bax, J., Betriu, A., Blomstrom-Lundqvist, C., Crea, F., Falk, V., Filippatos, G., Fox, K., Huber, K., Kastrati, A., Rosengren, A., Steg, P. G., Tubaro, M., Verheugt, F., Weidinger, F., Weis, M., ESC Committee for Practice Guidelines (CPG), , Vahanian, A., Camm, J., De Caterina, R., Dean, V., Dickstein, K., Filippatos, G., Funck-Brentano, C., Hellemans, I., Kristensen, S. D., McGregor, K., Sechtem, U., Silber, S., Tendera, M., Widimsky, P., Zamorano, J. L., Document Reviewers, , Silber, S., Aguirre, F. V., Al-Attar, N., Alegria, E., Andreotti, F., Benzer, W., Breithardt, O., Danchin, N., Mario, C. D., Dudek, D., Gulba, D., Halvorsen, S., Kaufmann, P., Kornowski, R., Lip, G. Y. H., Rutten, F. (2008). Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology:. Eur Heart J 29: 2909-2945 [Full Text]  
• Erbel, R., Delaney, J. A.C., Lehmann, N., McClelland, R. L., Mohlenkamp, S., Kronmal, R. A., Schmermund, A., Moebus, S., Dragano, N., Stang, A., Jockel, K.-H., Budoff, M. J., on behalf of the Multi-Ethnic Study of Atheroscler, (2008). Signs of subclinical coronary atherosclerosis in relation to risk factor distribution in the Multi-Ethnic Study of Atherosclerosis (MESA) and the Heinz Nixdorf Recall Study (HNR). Eur Heart J 29: 2782-2791 [Abstract] [Full Text]  
• Ostrom, M. P., Gopal, A., Ahmadi, N., Nasir, K., Yang, E., Kakadiaris, I., Flores, F., Mao, S. S., Budoff, M. J. (2008). Mortality Incidence and the Severity of Coronary Atherosclerosis Assessed by Computed Tomography Angiography. J Am Coll Cardiol 52: 1335-1343 [Abstract] [Full Text]  
• Elkeles, R. S., Godsland, I. F., Feher, M. D., Rubens, M. B., Roughton, M., Nugara, F., Humphries, S. E., Richmond, W., Flather, M. D., for the PREDICT Study Group, (2008). Coronary calcium measurement improves prediction of cardiovascular events in asymptomatic patients with type 2 diabetes: the PREDICT study. Eur Heart J 29: 2244-2251 [Abstract] [Full Text]  
• Budoff, M. J. (2008). Not all diabetics are created equal (in cardiovascular risk). Eur Heart J 29: 2193-2194 [Full Text]  
• Schmermund, A., Voigtlander, T., Nowak, B. (2008). The risk of marathon runners-live it up, run fast, die young?. Eur Heart J 29: 1800-1802 [Full Text]  
• Greenland, P., Lloyd-Jones, D. (2008). Defining a Rational Approach to Screening for Cardiovascular Risk in Asymptomatic Patients. J Am Coll Cardiol 52: 330-332 [Abstract] [Full Text]  
• Pletcher, M. J., Bibbins-Domingo, K., Lewis, C. E., Wei, G. S., Sidney, S., Carr, J. J., Vittinghoff, E., McCulloch, C. E., Hulley, S. B. (2008). Prehypertension during Young Adulthood and Coronary Calcium Later in Life. ANN INTERN MED 149: 91-99 [Abstract] [Full Text]  
• 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. (2008). Coronary Calcium and Events in Four Ethnic Groups. NEJM 359: 202-204 [Full Text]  
• Roelker, E. (2008). Screening for Coronary Artery Disease in Patients With Diabetes. Diabetes Spectr. 21: 166-171 [Abstract] [Full Text]  
• Golden, S. H., Lazo, M., Carnethon, M., Bertoni, A. G., Schreiner, P. J., Roux, A. V. D., Lee, H. B., Lyketsos, C. (2008). Examining a Bidirectional Association Between Depressive Symptoms and Diabetes. JAMA 299: 2751-2759 [Abstract] [Full Text]  
• (2008). Does the Predictive Value of Coronary Calcium Measurements Vary by Ethnic Group?. JWatch General 2008: 4-4 [Full Text]  
• (2008). All you need to read in the other general journals. BMJ 336: 744-745 [Full Text]  
• Weintraub, W. S., Diamond, G. A. (2008). Predicting Cardiovascular Events with Coronary Calcium Scoring. NEJM 358: 1394-1396 [Full Text]  
• (2008). The Coronary Artery Calcium Score as a Predictor of Coronary Events. Journal Watch Cardiology 2008: 2-2 [Full Text]