Progression of coronary calcium and incident coronary heart disease events: MESA (Multi-Ethnic Study of Atherosclerosis)

Matthew J. Budoff, Rebekah Young, Victor A. Lopez, Richard A. Kronmal, Khurram Nasir, Roger S. Blumenthal, Robert C. Detrano, Diane E. Bild, Alan D. Guerci, Kiang Liu, Steven Shea, Moyses Szklo, Wendy Post, Joao Lima, Alain Bertoni, Nathan D. Wong

Research output: Contribution to journalArticlepeer-review

306 Scopus citations


Objectives: The study examined whether progression of coronary artery calcium (CAC) is a predictor of future coronary heart disease (CHD) events. Background: CAC predicts CHD events and serial measurement of CAC has been proposed to evaluate atherosclerosis progression. Methods: We studied 6,778 persons (52.8% female) aged 45 to 84 years from the MESA (Multi-Ethnic Study of Atherosclerosis) study. A total of 5,682 persons had baseline and follow-up CAC scans approximately 2.5 ± 0.8 years apart; multiple imputation was used to account for the remainder (n = 1,096) missing follow-up scans. Median follow-up duration from the baseline was 7.6 (max = 9.0) years. CAC change was assessed by absolute change between baseline and follow-up CAC. Cox proportional hazards regression providing hazard ratios (HRs) examined the relation of change in CAC with CHD events, adjusting for age, gender, ethnicity, baseline calcium score, and other risk factors. Results: A total of 343 and 206 hard CHD events occurred. The annual change in CAC averaged 24.9 ± 65.3 Agatston units. Among persons without CAC at baseline (n = 3,396), a 5-unit annual change in CAC was associated with an adjusted HR (95% Confidence Interval) of 1.4 (1.0 to 1.9) for total and 1.5 (1.1 to 2.1) for hard CHD. Among those with CAC >0 at baseline, HRs (per 100 unit annual change) were 1.2 (1.1 to 1.4) and 1.3 (1.1 to 1.5), respectively. Among participants with baseline CAC, those with annual progression of ≥300 units had adjusted HRs of 3.8 (1.5 to 9.6) for total and 6.3 (1.9 to 21.5) for hard CHD compared to those without progression. Conclusions Progression of CAC is associated with an increased risk for future hard and total CHD events.

Original languageEnglish (US)
Pages (from-to)1231-1239
Number of pages9
JournalJournal of the American College of Cardiology
Issue number12
StatePublished - Mar 26 2013


  • Atherosclerosis
  • Coronary calcification
  • Coronary heart Disease
  • Imaging

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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