ABSTRACT
A total of 1,461 asymptomatic high-risk adult subjects were studied with digital subtraction fluoroscopy and conventional cinefluoroscopy to detect coronary calcium. Ethnicity and risk factor data were recorded. No subject had a history or electrocardiographic evidence of prior myocardial infarction. The prevalence of coronary calcium by digital subtraction fluoroscopy was high (58%). Substantial ethnic differences in prevalence were noted: 36% of African American subjects, 60% of Caucasian subjects, and 60% of Asian American subjects had definite radiographic evidence of coronary calcium. The difference in prevalence between African American and other subjects was significant (p < 0.0001) by chi-square test for all 3 races. These differences persisted in the unsubtracted cinefluoroscopic images (p < 0.0001) and after controlling for age, gender, and other risk factors (p = 0.003). After 20 +/- 11 months of follow-up, African Americans had more coronary artery disease events (13%) than Caucasians (6%) or Asian Americans (5%) (p = 0.04). Thus, African Americans have a significantly lower prevalence of coronary calcium than do Caucasians or Asian Americans. Based on the follow-up results, these differences in prevalence are not explained by differences in coronary artery disease risk.
Subject(s)
Calcium/metabolism , Coronary Disease/ethnology , Coronary Vessels/metabolism , Racial Groups , Aged , Analysis of Variance , Asian People , Black People , Chi-Square Distribution , Coronary Disease/diagnostic imaging , Coronary Disease/metabolism , Female , Fluoroscopy , Follow-Up Studies , Humans , Logistic Models , Male , Middle Aged , Multivariate Analysis , Prevalence , Radiographic Image Enhancement , Risk Factors , White PeopleABSTRACT
OBJECTIVES: This research investigated the prognostic significance of radiographically detectable coronary calcific deposits. BACKGROUND: Coronary calcific deposits are almost always associated with coronary atherosclerosis. We investigated the association between fluoroscopically determined coronary calcium and coronary heart disease end points at 1 year of follow-up. METHODS: This prospective population-based cohort study was conducted in the suburbs of Los Angeles. Fourteen hundred sixty-one asymptomatic adults with an estimated > or = 10% risk of having a coronary heart disease event within 8 years underwent cardiac cinefluoroscopy for assessment of coronary calcium at initiation of the study. Clinical status including angina, documented myocardial infarction, myocardial revascularization and death from coronary heart disease were determined after 1 year. RESULTS: The prevalence of calcific deposits was high (47%). A follow-up examination at 1 year was successfully completed in 99.9% of subjects. Six subjects (0.4%) had died from coronary heart disease and 9 (0.6%) had had a nonfatal myocardial infarction. Thirty-seven subjects (2.5%) reported angina pectoris, and 13 (0.9%) had undergone myocardial revascularization. Fifty-three subjects had at least one event during the 1-year period. Radiographically detectable calcium was associated with the presence of at least one of these end points, with a risk ratio of 2.7 (confidence limits 1.4, 4.6). The presence of coronary calcium was an independent predictor of at least one end point when controlling for age, gender and risk factors. However, three deaths due to coronary heart disease and two nonfatal myocardial infarctions occurred in subjects without detectable coronary calcium. CONCLUSIONS: The presence of coronary calcific deposits incurs an increased risk of coronary heart disease events in asymptomatic high risk subjects at 1 year. This increased risk is independent of that incurred by standard risk factors.
Subject(s)
Calcinosis/diagnostic imaging , Coronary Disease/diagnostic imaging , Myocardial Ischemia/epidemiology , Aged , Calcinosis/complications , Cineradiography , Coronary Disease/complications , Female , Humans , Logistic Models , Male , Middle Aged , Myocardial Ischemia/etiology , Myocardial Ischemia/mortality , Prognosis , Prospective Studies , Risk FactorsABSTRACT
Coronary calcific deposits are always associated with coronary atherosclerosis. Sensitive radiographic technology can detect coronary calcium before atherosclerosis becomes symptomatic. A total of 1461 asymptomatic high-risk adult subjects were studied with digital subtraction fluoroscopy to detect coronary calcium. Risk factor data were recorded including age, sex, family history, smoking history, diabetes history, body mass index, systolic blood pressure, left ventricular hypertrophy on ECG, total serum cholesterol level, high-density lipoprotein (HDL) cholesterol, and total cholesterol/HDL ratio. Digital subtraction fluoroscopy in the left anterior oblique projection was performed in all subjects. The prevalence of calcific deposits in at least one major coronary artery was high (58.3%). Eleven percent had coronary calcium in all three major arteries. Multivariate logistic regression analysis showed significant correlations (p < 0.05) between the prevalence of coronary calcium and age, smoking history (relative risk = 1.30), diabetes history (relative risk = 1.24), and family history (relative risk = 1.26). In older subjects (at least 65 years of age), smoking and serum lipoproteins assumed greater importance as contributors to coronary calcium, whereas in younger subjects a history of diabetes was more significant. Coronary calcific deposits are prevalent in high-risk asymptomatic subjects. Their occurrence is closely related to most known risk factors.
