Coronary Artery Calcium, Aortic Calcification and Density in MESA

摘要 在当前的医疗环境中，通过取消第二次测试(如专用测试)来降低成本 CAC的计算机断层扫描[CT])当临床相似的数据已经可用时(例如来自非 胸部对比CT(NCCT)是一个值得称赞的目标。更重要的是，许多心脏 如果偶然发现CAC或主动脉弓钙化(AAC)，事件可能会被预防 不仅提醒医生注意重大疾病的存在，而且还会引导适当的患者改变生活方式 和/或药物干预。最后，评估那些CAC分数高的没有遭遇事件的人 在接下来的20年里，将确定具有保护性并有可能减少误报的因素 与CAC检测相关，避免下游检测和药物使用。伴随而来的评估 在NCCT肺癌筛查中的CAC，也是一个识别无症状的机会 心血管(CVD)风险降低和增加的个体。此外，评估高级 CAC指标(即密度和位置)与AAC一起提高CAC性能是独一无二的。 这项研究旨在利用动脉粥样硬化的多种族研究(MESA)作为一项严格汇编和 高度验证的数据集，使用全面的表型，多种族和多民族队列。我们会 利用已经投入的大量资源收集近20,000个表现良好的NCCT来 使用20年仔细判定的心血管疾病来确定患病率、危险因素相关性和预后价值 随访并重复成像。具体来说，我们将在19861次扫描中测量AAC、CAC和密度：6814次 基线研究的参与者和梅萨肺研究参与者的5987次全肺CT(2010年为3187次- 12)和在考试6(2016-2018年)期间获得的2850人。科学的前提是这些冠状动脉外 钙化(ECC)可能预示着独立于CAC的心血管疾病的风险，而非增强CT(如 可作为CAC和ECC测量的一个可行来源。这个 Mesa Cohort提供了一个独特的机会，经过20多年的随访和委员会裁决的CVD 事件，以便在多种族中建立CAC检测的患病率和预后意义 以人群为基础的队列，同时考虑了钙密度和AAC的预后潜力。希望 这可以作为一种机制，提供适当的预防性治疗，强调治疗性 对那些在给定CAC阈值下处于较高预测风险的人进行干预。这些方面都是高度 创新的是，强调评估钙密度是一种降低风险的效果修饰物，适用于患有 更高的CAC是我们所知的独一无二的。随着拟议研究目标的实现，有价值的 将开发流行病学数据库，并有机会利用现有的NCCT来处理常规的心血管疾病风险 分层将更接近现实。我们认为这项提议意义重大，具有相当大的潜力 对预防心血管疾病的方法产生直接、积极的影响。

ABSTRACT In the current healthcare environment, reducing costs by eliminating a second test (such as a dedicated computed tomography [CT] for CAC) when clinically similar data is already available (such as from a non- contrast chest CT (NCCT) ordered for another indication) is a laudable goal. More importantly, many cardiac events could potentially be prevented if incidentally discovered CAC or aortic arch calcification (AAC) would not only alert physicians to the presence of significant disease but would steer appropriate patients for lifestyle and/or pharmacologic intervention. Finally, evaluating those with high CAC scores who do not suffer an event over the next 20 years will identify factors that are protective, and can potentially reduce false positives associated with CAC testing, avoiding downstream testing and medication use. The concomitant assessment of CAC during lung cancer screening with NCCT, represents an opportunity to also identify asymptomatic individuals at both decreased and increased cardiovascular (CVD) risk. Furthermore, evaluating advanced metrics of CAC (ie- density and location) along with AAC to improve CAC performance, is unique. This study poses to leverage the Multi-Ethnic Study of Atherosclerosis (MESA) as a rigorously compiled and highly validated dataset using a comprehensively phenotyped, multi-racial and multi-ethnic cohort. We will utilize the considerable resources already invested in the collection of almost 20,000 well performed NCCT to determine prevalence, risk factor associations, and prognostic value using 20 years of careful adjudicated CVD follow up and repeat imaging. Specifically, we will measure AAC, CAC, and density in 19,861 scans: 6,814 participants in the baseline study and 5,987 full lung CTs in participants of MESA Lung Study (3,187 in 2010- 12) and 2850 acquired during exam 6 (2016-2018). The scientific premise is that these extra-coronary calcifications (ECC) may portend risk for CVD independent of CAC, and that non-contrast CT (such as those obtained for lung cancer screening) can serve as a viable source of both CAC and ECC measurement. The MESA Cohort permits a unique opportunity, with over 20 year follow up and committee adjudicated CVD events, to allow establishment of prevalence and prognostic significance of CAC detection in a multi-ethnic population based cohort, with consideration of prognostic potential of both calcium density and AAC. The hope is that this may serve as a mechanism to deliver appropriate preventative treatment, emphasizing therapeutic intervention for those who are at higher predicted risk at a given CAC threshold. These aspects are highly innovative, as is the emphasis on evaluating calcium density as a de-risking, effect modifier for individuals with higher CAC is unique to our knowledge. With achievement of the proposed study aims, a valuable epidemiological database will be developed, and the opportunity to utilize existing NCCT for routine CVD risk stratification will move closer to reality. We feel the proposal is highly significant with considerable potential to exert a direct, positive impact on the approach to CVD prevention.