Association of thoracic aortic calcium with incident cardiovascular disease and all-cause mortality across the spectrum of coronary artery calcium burden

Association of thoracic aortic calcium with incident cardiovascular disease and all-cause mortality across the spectrum of coronary artery calcium burden

Background: Calcification of the ascending and/or descending thoracic aorta is easily measured via non-contrast cardiac computed tomography (CT), commonly performed for quantification of coronary artery calcium (CAC). We assessed whether thoracic aortic calcium (TAC) further improves long-term cardi...

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Main Authors: Alexander C. Razavi, Omar Dzaye, Miguel Cainzos-Achirica, Zeina Dardari, Marly Van Assen, Arshed A. Quyyumi, Khurram Nasir, J. Jeffrey Carr, Matthew J. Budoff, Roger S. Blumenthal, Paolo Raggi, Carlo N. De Cecco, Laurence S. Sperling, Michael J. Blaha, Seamus P. Whelton
Format: Article
Language:English
Published: Elsevier 2025-03-01
Series:American Journal of Preventive Cardiology
Subjects:
Thoracic aorta
Thoracic aortic calcium
Vascular calcification
Computed tomography
Atherosclerosis
Coronary artery calcium
Online Access:http://www.sciencedirect.com/science/article/pii/S266666772400285X
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Summary:Background: Calcification of the ascending and/or descending thoracic aorta is easily measured via non-contrast cardiac computed tomography (CT), commonly performed for quantification of coronary artery calcium (CAC). We assessed whether thoracic aortic calcium (TAC) further improves long-term cardiovascular disease (CVD) risk stratification beyond CAC alone. Methods: Cardiac CT was performed among 6,783 asymptomatic Multi-Ethnic Study of Atherosclerosis participants at baseline. Cox proportional hazards regression assessed the association of TAC with incident CVD and all-cause mortality over a median follow-up of 17.7 years, adjusting for CVD risk factors and CAC. Results: The mean age was 62.1 years old, 53% were female, and 28% had TAC. Over a median follow-up of 17.7 years, 48% of participants with TAC ≥500 experienced CVD and 72% died. Compared to TAC=0, TAC ≥500 was significantly associated with an increased risk of CVD (HR=1.28, 95% CI: 1.06-1.54) and all-cause mortality (HR=1.44, 95% CI: 1.25–1.65), with the strongest association among persons with CAC=0 (CVD HR=1.79, 95% CI: 1.04–3.07; all-cause mortality HR=1.82, 95% CI: 1.29–2.56). The addition of TAC to traditional risk factors and CAC did not improve CVD discrimination (ΔC-statistic=+0.002, p=0.12), but incrementally improved prediction of all-cause mortality (CVD: ΔC-statistic=+0.002, p=0.02). Conclusions: Participants with TAC ≥500 had a high long-term risk for CVD and all-cause mortality. TAC primarily improved risk stratification among persons with CAC=0.
ISSN:2666-6677

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