Association of Thoracic Aortic Calcium with Incident Cardiovascular Disease and All-cause Mortality Across the Spectrum of Coronary Artery Calcium Burden

Overview

Journal Am J Prev Cardiol

Date 2025 Feb 3

PMID 39896051

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

Affiliations

Soon will be listed here.

Abstract

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, =0.12), but incrementally improved prediction of all-cause mortality (CVD: ΔC-statistic=+0.002, =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.

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