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Eur Heart J. 2014 Nov 7;35(42):2960-71. doi: 10.1093/eurheartj/ehu288. Epub 2014 Jul 25.

Progression of coronary artery calcification seems to be inevitable, but predictable - results of the Heinz Nixdorf Recall (HNR) study.

Author information

1
University Clinic of Cardiology, West-German Heart Center Essen and erbel@uk-essen.de.
2
Institute for Medical Informatics, Biometry and Epidemiology, University Duisburg-Essen, Hufelandstrasse 55, Essen D-45122, Germany.
3
University Clinic of Cardiology, West-German Heart Center Essen and.
4
University Clinic of Cardiology, West-German Heart Center Essen and Medical Clinic II, Bethanien Hospital, Moers, Germany.
5
Alfred-Krupp Hospital, Essen, Germany.
6
Cardioangiological Center Bethanien, Frankfurt am Main, Germany.
7
Institute of Clinical Epidemiology, Medical Faculty University Halle-Wittenberg, Wittenberg, Germany Department of Epidemiology, School of Public Health, Boston University, Boston, MA, USA.
8
Institute of Clinical Chemistry and Laboratory Medicine, University Duisburg-Essen, Essen, Germany.
9
University Clinic of Neurology, University Duisburg-Essen, Essen, Germany.
10
Institute of Medical Sociology Medical Faculty University of Düsseldorf, Düsseldorf, Germany.

Abstract

AIM:

Coronary artery calcification (CAC), as a sign of atherosclerosis, can be detected and progression quantified using computed tomography (CT). We develop a tool for predicting CAC progression.

METHODS AND RESULTS:

In 3481 participants (45-74 years, 53.1% women) CAC percentiles at baseline (CACb) and after five years (CAC₅y) were evaluated, demonstrating progression along gender-specific percentiles, which showed exponentially shaped age-dependence. Using quantile regression on the log-scale (log(CACb+1)) we developed a tool to individually predict CAC₅y, and compared to observed CAC₅y. The difference between observed and predicted CAC₅y (log-scale, mean±SD) was 0.08±1.11 and 0.06±1.29 in men and women. Agreement reached a kappa-value of 0.746 (95% confidence interval: 0.732-0.760) and concordance correlation (log-scale) of 0.886 (0.879-0.893). Explained variance of observed by predicted log(CAC₅y+1) was 80.1% and 72.0% in men and women, and 81.0 and 73.6% including baseline risk factors. Evaluating the tool in 1940 individuals with CACb>0 and CACb<400 at baseline, of whom 242 (12.5%) developed CAC₅y>400, yielded a sensitivity of 59.5%, specificity 96.1%, (+) and (-) predictive values of 68.3% and 94.3%. A pre-defined acceptance range around predicted CAC₅y contained 68.1% of observed CAC₅y; only 20% were expected by chance. Age, blood pressure, lipid-lowering medication, diabetes, and smoking contributed to progression above the acceptance range in men and, excepting age, in women.

CONCLUSION:

CAC nearly inevitably progresses with limited influence of cardiovascular risk factors. This allowed the development of a mathematical tool for prediction of individual CAC progression, enabling anticipation of the age when CAC thresholds of high risk are reached.

KEYWORDS:

CT; Coronary artery calcification; Epidemiology; Heinz Nixdorf Recall study; Imaging; Progression of atherosclerosis

PMID:
25062951
PMCID:
PMC4223611
DOI:
10.1093/eurheartj/ehu288
[Indexed for MEDLINE]
Free PMC Article

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