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Malay ethnicity, smoking, hyperlipidaemia predict risk of coronary calcification

Stephen Padilla
28 May 2018

Malay ethnicity, male gender, smoking and having hyperlipidaemia are associated with an increased risk of coronary calcification, according to a study presented at the Asian Pacific Society of Cardiology (APSC) Congress 2018 in Taipei, Taiwan.

“Coronary artery calcium (CAC) is highly associated with the presence of coronary atherosclerotic plaque that has prognostic value towards cardiovascular events,” lead author Shu Yun Heng said. “It has shown that CAC varies among different ethnic groups in the same age and gender.”

Multivariate analysis of 16,546 individuals revealed that CAC increased with increasing age (adjusted odds ratio [AOR], 1.13; 95 percent CI, 1.13–1.14). Compared with women, men had higher CAC score across all ages (AOR, 3.70; 3.41–4.02).

Individuals of Malay ethnicity generally had higher CAC compared with those of Chinese ethnicity (AOR, 1.37; 1.16–1.63), after adjusting for confounding variables. In addition, CAC was also higher in smokers than nonsmokers (AOR, 13.29; 1.43–123.87) and among individuals with hyperlipidaemia (AOR, 1.62; 1.02–2.58).

These results are consistent with those of the Multi-Ethnic Study of Atherosclerosis (MESA), which found that men had greater calcium levels than women, and calcium amount and prevalence were steadily higher with increasing age. Researchers also found significant differences in calcium by race, and these associations differed across age and gender. [Circulation 2006;113:30-73]

A prospective cohort study, MESA is designed to assess subclinical cardiovascular disease (CVD) in a multiethnic cohort free of clinical CVD. A total of 6,110 patients (mean age 62 years; 53 percent women) participated in the study. [Circulation 2006;113:30-73]

The MESA public website (http://www.mesa-nhlbi.org) provides an interactive form that allows one to enter an age, gender, race/ethnicity, and CAC score to obtain a corresponding estimated percentile.

Bild and colleagues, in one publication of the MESA results, also found ethnic differences in the presence and quantity of coronary calcification that were not explained by coronary risk factors. [Circulation 2005;111:1313-1320]

“Identification of the mechanism underlying these differences would further our understanding of the pathophysiology of coronary calcification and its clinical significance,” said Bild, adding that “[d]ata on the predictive value of coronary calcium in different ethnic groups are needed.”

Furthermore, data from another study focusing on the prognostic value of CAC in a large, ethnically diverse cohort for the prediction of all-cause mortality support a growing body of evidence noting substantial differences in cardiovascular risk by ethnicity. [J Am Coll Cardiol 2018;doi:10.1016/j.jacc.2007.03.066]

In this present retrospective study, Heng and colleagues assessed the distribution of CAC in a multiethnic cohort between ages 35–84 years from a single tertiary institution, National Heart Centre Singapore, between 2007 and 2017. Participants were 64 percent men and had a mean age of 55 years. CAC was determined by 320 Multi-Detector Row CT.

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