American Journal of Epidemiology Advance Access published online on May 9, 2007
American Journal of Epidemiology, doi:10.1093/aje/kwm091
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Original Contribution |
A Comparison of Risk Factors for Calcified Atherosclerotic Plaque in the Coronary, Carotid, and Abdominal Aortic Arteries
The Diabetes Heart Study
1 Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
2 Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
3 Division of Radiologic Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
4 Department of Biochemistry, Wake Forest University School of Medicine, Winston-Salem, NC
Correspondence to Dr. Lynne E. Wagenknecht, Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157 (e-mail: lwgnkcht{at}wfubmc.edu).
Received for publication October 11, 2006. Accepted for publication February 19, 2007.
The extent of shared risk factors for calcified atherosclerotic plaque (CAP) of the coronary, carotid, and abdominal aortic arteries is unknown. CAP was measured by computed tomography in 1,125 individuals in families affected with diabetes. Statistical methods adjusted for the lack of independence between observations. CAP scores were standardized, and tests of interaction were conducted to compare risk factor relations across vascular beds. The average age of the cohort was 61 years, and 84% had diabetes. The correlation in CAP scores across vascular beds ranged from 0.59 to 0.72. Age, albumin/creatinine ratio, hemoglobin A1c, diabetes, hypertension, and lipid-lowering therapy were correlated with quantity of CAP in all vascular beds (all p < 0.05); no differences in the strength of these relations were noted. In contrast, other significant correlates differed in the strength of their relations with CAP. The risk factor pack-years of smoking was most strongly correlated with CAP in the abdominal aorta (p < 0.005). Male gender, previous myocardial infarction, and coronary revascularization were most strongly correlated with CAP in the coronary arteries (p < 0.0001). In summary, CAPs of the coronary, carotid, and abdominal aortic arteries generally share common risk factors, even though several of these factors have a greater impact on CAP in one vascular bed than another.
atherosclerosis; calcification, physiologic; diabetes mellitus, type 2; North Carolina; risk factors; siblings
Abbreviations: CAP, calcified atherosclerotic plaque; GEE, generalized estimating equation