Arterial Age as a Function of Coronary Artery Calcium (from the Multi-Ethnic Study of Atherosclerosis [MESA])

doi:10.1016/j.amjcard.2008.08.031

The American Journal of Cardiology

Volume 103, Issue 1, 1 January 2009, Pages 59-63

https://doi.org/10.1016/j.amjcard.2008.08.031 Get rights and content

It has been proposed that coronary artery calcium (CAC) can be used to estimate arterial age in adults. Supporting this concept is that chronologic age, as used in cardiovascular risk assessment, is a surrogate for atherosclerotic burden. This measure can provide patients with a more understandable version of their CAC scores (e.g., “You are 55 years old, but your arteries are more consistent with an arterial age of 65 years”). The aim of this study was to describe a method of calculating arterial age by equating estimated coronary heart disease (CHD) risk for observed age and CAC. Arterial age is then the risk equivalent of CAC. Data from the Multi-Ethnic Study of Atherosclerosis (MESA), a cohort study of 6,814 participants free of clinical cardiovascular disease and followed for an average of 4 years, were used. Estimated arterial age was obtained as a simple linear function of log-transformed CAC. In a model for incident CHD risk controlling for age and arterial age, only arterial age was significant, indicating that observed age does not provide additional information after controlling for arterial age. Framingham risk calculated using this arterial age was more predictive of short-term incident coronary events than Framingham risk on the basis of observed age (area under the receiver-operating characteristic curve 0.75 for Framingham risk on the basis of observed age and 0.79 using arterial age, p = 0.006). In conclusion, arterial age provides a convenient transformation of CAC from Agatston units to a scale more easily appreciated by patients and treating physicians.

Section snippets

Methods

MESA is a prospective cohort study of the prevalence, risk factors, and progression of subclinical cardiovascular disease in a multiethnic community-based cohort. A detailed description of the study design and methods has been published previously.⁸ Briefly, 6,814 participants aged 45 to 84 years who identified themselves as white, African American, Hispanic, or Chinese were recruited from 6 communities in the United States from 2000 to 2002. All participants were free of clinically apparent

Results

The MESA cohort is composed of 53% women, with 39% of the cohort Caucasian, 12% Chinese American, 28% African American, and 22% Hispanic American. The average age is 62 years, with a range of 45 to 84 years. Over an average of 4 years of follow-up, 189 incident CHD events were observed in MESA, including 108 hard CHD events (myocardial infarction and CHD death). Estimated arterial age is given by $\hat{A} = 39.1 + 7.25 \log (CAC + 1)$ , with the approximate standard error (SE) given by $s e (\hat{A}) ≅ \sqrt{13.7 - 6.5 \log (c a c + 1)}$

Discussion

Most previous studies have estimated arterial age as the age for which the expected CAC is equal to the observed CAC. Shaw et al³ regressed observed age on observed CAC and then estimated “biologic age” by the fitted values from this model. A feature of this model is that anyone with zero CAC will be assigned the model intercept, which in our data was just slightly younger than the average age of the cohort. Thus, anyone younger than the average age of the cohort with a zero score will have a

Acknowledgment

We thank the other investigators, the staff members, and the participants of the MESA study for their valuable contributions. A full list of participating MESA investigators and institutions can be found at http://www.mesa-nhlbi.org.

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Citation Excerpt :
In addition, it has been suggested that the assessment of vascular age on the basis of coronary artery calcium score (CACS) is a reliable method [6,7]. The concept is to determine the age that is associated with the same coronary heart disease (CHD) risk as the observed CACS, hence defining the arterial age of each participant [8]. In these circumstances, arterial age and health becomes even more important because arterial pulsation and relaxation are most relevant for a sufficiently working glymphatic system of the brain, and thereby for aging in general [9–12].
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: This research was supported by Contracts N01-HC-95159 through N01-HC-95165 and N01-HC-95169 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland.

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Preventive cardiologyArterial Age as a Function of Coronary Artery Calcium (from the Multi-Ethnic Study of Atherosclerosis [MESA])

Section snippets

Methods

Results

Discussion

Acknowledgment

Atherosclerosis

Int J Cardiol

J Am Coll Cardiol

Vascular age: integrating carotid intima-media thickness measurements with global coronary risk assessment

Clin Cardiol

Coronary age as a risk factor in the modified Framingham risk score

BMC Med Imaging

Calculation of coronary age using calcium scores in multiple ethnicities

Int J Cardiovasc Imaging

Age as a risk factor: you are as old as your arteries

Am J Cardiol

Preventive cardiology
Arterial Age as a Function of Coronary Artery Calcium (from the Multi-Ethnic Study of Atherosclerosis [MESA])