Guallar E, Zhao D, Pastor-Barriuso R, Rampal S, Chang Y, Ryu S, Choi Y, Lima J, Lim SY, Cainzos Achirica M, Shin H, Cho J, Zhang Y. Associations of early and contemporary cardiovascular risk factors with coronary artery calcification. Poster presented at the American Heart Association and American Stroke Association EPI-Lifestyle 2015; March 2015. Baltimore, MD. [abstract] Circulation. 2015 Mar 10; 131(Suppl 1).


OBJECTIVE: Traditional cardiovascular disease (CVD) risk factors are key determinants of atherosclerosis and essential components of preventive interventions. However, it is unclear whether the associations between risk factors and atherosclerosis are time-dependent and whether early or contemporary risk factor levels are more important determinants of CVD risk.

HYPOTHESIS: The aim of this study was to test the hypothesis that early (up to 10 years previous) CVD risk factor levels are stronger determinants of coronary artery calcium (CAC), a measure of subclinical atherosclerosis, compared to contemporary levels or risk factors.

METHODS:
We conducted a cohort study of 45,933 young and middle-aged men and women without clinically evident CVD who underwent repeated comprehensive health exams from 2002-2013 and had a measurement of CAC score by computed tomography during 2010-2013. The time-dependent associations of CAC with cardiovascular risk factors measured at different time points prior to the CAC assessment were examined using robust Tobit and logistic regression models.

RESULTS: Early measures of BMI, total and LDL cholesterol, triglycerides, SBP and DBP were more strongly associated with the presence and severity of coronary calcification compared to contemporary measures, whereas contemporary HDL was more strongly associated with CAC compared to earlier measures. For BMI, total and LDL cholesterol, triglycerides, SBP and DBP, the strength of the association with CAC scores increased linearly with increasing distance from the time of CAC measurement (Figure).

CONCLUSIONS: In this large sample of young and middle-aged adults, the association between traditional risk factors and CAC score was stronger for early compared to contemporary measures for all risk factors except HDL. These findings underscore the importance of long-term trajectories in the pathogenesis of atherosclerosis as well as the potential benefit of early CVD risk assessment.

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