Coronary Artery Calcium and Incident Cerebrovascular Events in an Asymptomatic Cohort: The MESA Study | Journal Scan

Study Questions:

Is coronary artery calcium (CAC) score a predictive measure for cerebrovascular events (CVEs)?


Data for the present study were collected as part of the MESA study (Multi-Ethnic Study of Atherosclerosis), which followed participants over an average of 9.5 years. Participants (ages 45-84 years at baseline) who had CAC measures at baseline, and who had no strokes or transient ischemic attack [TIA] or a history of atrial fibrillation at baseline, were included. The primary outcome of interest was CVEs. The Framingham stroke risk score (FSRS) was calculated for each MESA participant (using baseline data only) using the following variables: age, systolic blood pressure, diabetes mellitus, cigarette smoking, prior cardiovascular disease, atrial fibrillation, left ventricular hypertrophy (electrocardiogram criteria), and blood pressure medications.


A total of 6,779 men and women were included in the present study. After a mean of 9.5 ± 2.4 years, 234 (3.5%) adjudicated CVEs (180 strokes and 67 TIAs) were identified. Ischemic CVEs (cerebral infarcts and TIAs) were observed in 206 (3.4%) participants, of whom 152 (2.2%) had cerebral infarcts. Participants who developed a CVE were older, had a worse cardiovascular risk profile, and developed atrial fibrillation more often (17.1% vs. 5.6%) during the follow-up period than those who did not have a CVE. In Kaplan-Meier analysis, the presence of CAC was associated with a lower CVE event-free survival versus the absence of CAC (p < 0.0001). Log-transformed CAC was associated with increased risk for CVEs 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, 1.13 [95% confidence interval, 1.07-1.20]; p < 0.0001). CAC was an independent predictor of CVEs when analysis was stratified by sex or race/ethnicity and improved discrimination for CVEs when added to the full model (c-statistic, 0.744 vs. 0.755). CAC also improved the discriminative ability of the FSRS for CVEs.


The authors concluded that CAC is an independent predictor of CVEs and improves the discrimination afforded by current stroke risk factors or the FSRS for incident CVEs in an initially asymptomatic multiethnic adult cohort.


These data suggest that CAC is a clinically important predictor for risk of future CVEs. Such information may be used to identify patients for aggressive prevention efforts. However, such an intervention must be evaluated prior to widespread adoption of CAC testing.

Clinical Topics: Arrhythmias and Clinical EP, Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Atrial Fibrillation/Supraventricular Arrhythmias, Lipid Metabolism, Nonstatins, Smoking

Keywords: Atrial Fibrillation, Blood Pressure, Body Mass Index, Calcium, Cerebral Infarction, Cholesterol, HDL, Coronary Vessels, Diabetes Mellitus, Disease-Free Survival, Electrocardiography, Hypertrophy, Left Ventricular, Ischemic Attack, Transient, Risk Factors, Smoking, Stroke

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