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JACC Cardiovasc Imaging. 2014 Nov;7(11):1108-15. doi: 10.1016/j.jcmg.2014.07.009. Epub 2014 Nov 10.

Coronary artery calcium and incident cerebrovascular events in an asymptomatic cohort. The MESA Study.

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Heart and Vascular Center of Excellence, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Heart and Vascular Center of Excellence, Wake Forest University School of Medicine, Winston-Salem, North Carolina. Electronic address:



This study assessed the predictive value of coronary artery calcium (CAC) score for cerebrovascular events (CVE) in an asymptomatic multiethnic cohort.


The CAC score, a measure of atherosclerotic burden, has been shown to improve prediction of coronary heart disease events. However, the predictive value of CAC for CVE is unclear.


CAC was measured at baseline examination of participants (N = 6,779) of MESA (Multi-Ethnic Study of Atherosclerosis) and then followed for an average of 9.5 ± 2.4 years for the diagnosis of incident CVE, defined as all strokes or transient ischemic attacks.


During the follow-up, 234 (3.5%) adjudicated CVE occurred. In Kaplan-Meier analysis, the presence of CAC was associated with a lower CVE event-free survival versus the absence of CAC (log-rank chi-square: 59.8, p < 0.0001). Log-transformed CAC was associated with increased risk for CVE after adjusting for age, sex, race/ethnicity, body mass index, systolic and diastolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, cigarette smoking status, blood pressure medication use, statin use, and interim atrial fibrillation (hazard ratio [HR]: 1.13 [95% confidence interval (CI): 1.07 to 1.20], p < 0.0001). The American College of Cardiology/American Heart Association-recommended CAC cutoff was also an independent predictor of CVE and strokes (HR: 1.70 [95% CI: 1.24 to 2.35], p = 0.001, and HR: 1.59 [95% CI: 1.11 to 2.27], p = 0.01, respectively). CAC was an independent predictor of CVE when analysis was stratified by sex or race/ethnicity and improved discrimination for CVE when added to the full model (c-statistic: 0.744 vs. 0.755). CAC also improved the discriminative ability of the Framingham stroke risk score for CVE.


CAC is an independent predictor of CVE and improves the discrimination afforded by current stroke risk factors or the Framingham stroke risk score for incident CVE in an initially asymptomatic multiethnic adult cohort.


cerebrovascular disease; coronary artery calcium score; prevention; risk prediction

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