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Master of Public Health

Discordance Between Coronary Artery Calcium Area and Density Predicts Long-Term Atherosclerotic Cardiovascular Disease Risk

AUTHORS

Razavi AC , van Assen M , De Cecco CN , Dardari ZA , Berman DS , Budoff MJ , Miedema MD , Nasir K , Rozanski A , Rumberger JA , Shaw LJ , Sperling LS , Whelton SP , Mortensen MB , Blaha MJ , Dzaye O , . JACC. Cardiovascular imaging. 2022 7 11; ().

ABSTRACT

BACKGROUND: Coronary artery calcium (CAC) is commonly quantified as the product of two generally correlated measures: plaque area and calcium density.

OBJECTIVE: We sought to determine whether discordance between calcium area and density has long-term prognostic importance in atherosclerotic cardiovascular disease (ASCVD) risk.

METHODS: We studied 10,373 primary prevention participants from the CAC Consortium with CAC>0. Based on their median values, calcium area and mean calcium density were divided into four mutually exclusive concordant/discordant groups. Cox proportional hazards regression assessed the association of calcium area/density groups with ASCVD mortality over a median of 11.7 years, adjusting for traditional risk factors and the Agatston CAC score.

RESULTS: The mean age was 56.7 years old and 24% were female. The prevalence of plaque discordance was 19% (9% low calcium area-high calcium density, 10% high calcium area-low calcium density). Female sex (OR=1.48, 95% CI: 1.27-1.74) and body mass index (OR=0.81, 0.76-0.87, per 5 kg/m higher) significantly associated with high calcium density discordance, whereas diabetes (OR=2.23, 95% CI: 1.85-3.19) was most strongly associated with discordantly low calcium density. Compared to those with low calcium area-low calcium density, individuals with low calcium area-high calcium density had a 71% lower risk of ASCVD death (HR=0.29, 95% CI: 0.09-0.95).

CONCLUSIONS: For a given CAC score, high calcium density relative to plaque area confers lower long-term ASCVD risk, likely serving as an imaging marker of biological resilience for lesion vulnerability. Additional research is needed to define a robust definition of calcium area-density discordance for routine clinical risk prediction.

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