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The Coronary Artery Calcium Score as a Predictor of Coronary Events
A multiethnic study strengthens the evidence for CAC as a risk factor in coronary disease but not the case for including it in routine risk assessment.
Several studies have established the association of coronary artery calcium (CAC) scores with risk for adverse coronary events, but these studies have not included large numbers of subjects from varied ethnic groups. Investigators used data from the Multi-Ethnic Study of Atherosclerosis (MESA) — a prospective, population-based study of samples from six urban communities — to determine how CAC relates to coronary events in four major ethnic groups.
About half of the 6722 adult participants (approximate mean age, 62) were women. The prevalence of measurable CAC was 70% and 45% for white men and women, respectively; 52% and 37% for black men and women, respectively; 57% and 35% for Hispanic men and women, respectively; and 59% and 42% for Chinese men and women, respectively. During a median follow-up of 3.9 years, 162 participants experienced a coronary event, including 72 who had an acute MI and 17 who died of coronary heart disease. Higher CAC scores were associated with higher risk for a coronary event. Adjusting for standard risk factors, a doubling of the CAC score was associated with a 20% increase in the risk for a major event. No interaction by ethnic group was found, indicating that the association was independent of ethnicity.
Comment: This study lends further support to the general utility of the coronary artery calcium score for predicting risk for coronary events, although there were some interesting differences in the prevalence of CAC among ethnic groups. What remains unclear is how this test should best be used (or if it should be used at all) to achieve better outcomes for patients.
Published in Journal Watch Cardiology March 26, 2008
Citation(s):
Detrano R et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med 2008 Mar 27; 358:1336.
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