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Risk Factors and Association With Coronary Heart Disease, Stroke, and Peripheral Vascular Disease

Carlos Iribarren, MD, MPH, PhD; Stephen Sidney, MD, MPH; Barbara Sternfeld, PhD; Warren S. Browner, MD, MPH

JAMA. 2000;283:2810-2815.

Context  Calcium deposits in coronary and extracoronary arterial beds may indicate the extent of atherosclerosis. However, the incremental predictive value of vascular calcification, beyond traditional coronary risk factors, is not clearly established.

Objective  To evaluate risk factors for aortic arch calcification and its long-term association with cardiovascular diseases in a population-based sample.

Design and Setting  Cohort study conducted at a health maintenance organization in northern California.

Participants  A total of 60,393 women and 55,916 men, aged 30 to 89 years at baseline who attended multiphasic health checkups between 1964 and 1973 and for whom incidence of hospitalizations and/or mortality data were ascertained using discharge diagnosis codes and death records through December 31, 1997 (median follow-up, 28 years).

Main Outcome Measure  Hospitalization for or death due to coronary heart disease, ischemic stroke, hemorrhagic stroke, or peripheral vascular disease, as associated with aortic arch calcification found on chest radiograph at checkup from 1964-1973.

Results  Aortic arch calcification was present in 1.9% of men and 2.6% of women. It was independently associated with older age, no college education, current smoking, and hypertension in both sexes, but it was inversely related to body mass index and family history of myocardial infarction. In women, aortic arch calcification was also associated with black race and elevated serum cholesterol level. After adjustment for age, educational attainment, race/ethnicity, cigarette smoking, alcohol consumption, body mass index, serum cholesterol level, hypertension, diabetes, and family history of myocardial infarction, aortic arch calcification was associated with an increased risk of coronary heart disease (in men, relative risk [RR], 1.27; 95% confidence interval [CI], 1.11-1.45; in women, RR, 1.22; 95% CI, 1.07-1.38). Among women, it was also independently associated with a 1.46-fold increased risk of ischemic stroke (95% CI, 1.28-1.67).

Conclusion  In our population-based cohort, aortic arch calcification was independently related to coronary heart disease risk in both sexes as well as to ischemic stroke risk in women.

Author Affiliations: Kaiser Permanente Division of Research, Oakland, Calif (Drs Iribarren, Sidney, and Sternfeld); Departments of Epidemiology and Biostatistics (Dr Iribarren), General Internal Medicine Section (Dr Browner), University of California, San Francisco; and Department of Veterans Affairs Medical Center, San Francisco (Dr Browner).

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