Predictors of long-term absence of coronary artery calcium in individuals with high blood pressure: results from the MESA study.

Pubmed ID: 37155413

Pubmed Central ID: PMC10167869

Journal: Annals of medicine

Publication Date: Dec. 1, 2023

MeSH Terms: Humans, Male, Female, Cardiovascular Diseases, Risk Factors, Hypertension, Risk Assessment, Coronary Artery Disease, Atherosclerosis, Calcium, Vascular Calcification, Coronary Vessels

Grants: N01HC95167, N01HC95159

Authors: Gao JW, Zhang SL, Hao QY, Zhang HF, Wang JF, Liu PM, Han JJ, You S, Xiong ZC

Cite As: You S, Gao JW, Zhang HF, Xiong ZC, Hao QY, Han JJ, Wang JF, Zhang SL, Liu PM. Predictors of long-term absence of coronary artery calcium in individuals with high blood pressure: results from the MESA study. Ann Med 2023 Dec;55(1):2209334.

Studies:

Abstract

BACKGROUND & AIMS: Individuals with high blood pressure (BP) have varying risks of cardiovascular events due to other coexisting factors. We aimed to identify the predictors of long-term absence of coronary artery calcium (CAC) in individuals with high BP, which is an indicator of healthy arterial aging and can guide preventive strategies. METHODS: We analyzed data from participants with high BP (≥120/80 mm Hg) in the Multi-Ethnic Study of Atherosclerosis who had baseline CAC = 0 and underwent a second CAC scanning after 10 years. We used multivariable logistic regression to evaluate the association between various risk factors for atherosclerotic cardiovascular disease (ASCVD) and long-term CAC = 0. We also calculated the area under the receiver operating characteristic curve (AUC) to predict the phenotype of healthy arterial aging in this population. RESULTS: We included 830 participants (37.6% male, mean ± SD age of 59.4 ± 8.7 years). During follow-up, 46.5% of participants (<i>n</i> = 386) had CAC = 0, and they were younger and had fewer metabolic syndrome components. Adding ASCVD risk factors to the demographic model (age, sex, and ethnicity) moderately increased the predictive value for long-term CAC = 0 (AUC: demographic model + ASCVD risk factors vs. demographic model alone, 0.653 vs. 0.597, <i>p</i> &lt; .001; category net reclassification improvement = 0.104, <i>p</i> = .044; integrated discrimination improvement = 0.040, <i>p</i> &lt; .001). CONCLUSION: In individuals with high BP and initial CAC = 0, over 40% maintained CAC = 0 during a 10-year follow-up, which was associated with fewer ASCVD risk factors. These findings may have implications for preventive strategies in individuals with high BP.<b>Clinical Trial registration number:</b> The MESA was registered at clinical trials. gov as NCT00005487.<b>KEY MESSAGES</b>Nearly half (46.5%) of individuals with high blood pressure (BP) maintained a long-term absence of coronary artery calcium (CAC) during a 10-year follow-up, and this was associated with a 66.6% lower risk of atherosclerotic cardiovascular disease (ASCVD) events compared to those who developed incident CAC.Individuals with high BP, who are usually assumed to have an increased risk of ASCVD, exhibit significant heterogeneity in their ASCVD risk; those who maintain CAC = 0 have a lower ASCVD risk.Adding overall ASCVD risk factors to demographic information resulted in a moderate improvement in predicting long-term CAC = 0.