Carotid Intima-Media Thickness Score,Positive Coronary Artery Calcium Score,and Incident Coronary Heart Disease: the Multi-Ethnic Study of Atherosclerosis

Background: common carotid artery and internal carotid artery intima-media thicknesses (imt) are associated with coronary heart disease (chd) and increase with age. using age,sex,and race/ethnicity imt percentiles may improve chd prediction when added to framingham risk factors and coronary artery calcium score. we study these possibilities in the multi-ethnic study of atherosclerosis (mesa),a multi-ethnic cohort of whites,chinese,blacks,and hispanics.methods and results: imt data were acquired in the age range 45 to 84 years. common carotid artery and internal carotid artery imt,sex,and race/ethnic specific normative values were calculated for each mesa participant and combined as an imt score. multivariable cox-proportional hazards models and logistic regression models were generated with chd as outcome adding the imt score to (1) a base model with framingham risk factors,sex,race/ethnicity and (2) the base model with coronary artery calcium added. harrell's c-statistics and area under the curve were estimated. median follow-up was 10.2 years (interquartile range: 9.7,10.7 years) with 429 first-time chd events. mean age was 62.1 years and 52.6% of participants were women. imt score increased the base area under the curve from 0.7210 to 0.7396 (p=0.0008) and with positive coronary artery calcium score added to the model,from 0.7627 to 0.7714 (p=0.02).conclusions: a carotid imt score based on normative data incrementally adds to framingham risk factors and a positive calcium score in predicting first-time chd in an ethnically diverse cohort. © 2017 the authors. published on behalf of the american heart association,inc.,by wiley blackwell.