• Robert Detrano, Alan D Guerci, J Jeffrey Carr, Diane E Bild, Gregory Burke, Aaron R Folsom, Kiang Liu, Steven Shea, Moyses Szklo, David A Bluemke, Daniel H O'Leary, Russell Tracy, Karol Watson, Nathan D Wong, and Richard A Kronmal.
• Department of Radiological Sciences, University of California at Irvine, Irvine, CA 92697, USA. robert@chinacal.org
• N. Engl. J. Med. 2008 Mar 27; 358 (13): 133613451336-45.

BackgroundIn white populations, computed tomographic measurements of coronary-artery calcium predict coronary heart disease independently of traditional coronary risk factors. However, it is not known whether coronary-artery calcium predicts coronary heart disease in other racial or ethnic groups.MethodsWe collected data on risk factors and performed scanning for coronary calcium in a population-based sample of 6722 men and women, of whom 38.6% were white, 27.6% were black, 21.9% were Hispanic, and 11.9% were Chinese. The study subjects had no clinical cardiovascular disease at entry and were followed for a median of 3.8 years.ResultsThere were 162 coronary events, of which 89 were major events (myocardial infarction or death from coronary heart disease). In comparison with participants with no coronary calcium, the adjusted risk of a coronary event was increased by a factor of 7.73 among participants with coronary calcium scores between 101 and 300 and by a factor of 9.67 among participants with scores above 300 (P<0.001 for both comparisons). Among the four racial and ethnic groups, a doubling of the calcium score increased the risk of a major coronary event by 15 to 35% and the risk of any coronary event by 18 to 39%. The areas under the receiver-operating-characteristic curves for the prediction of both major coronary events and any coronary event were higher when the calcium score was added to the standard risk factors.ConclusionsThe coronary calcium score is a strong predictor of incident coronary heart disease and provides predictive information beyond that provided by standard risk factors in four major racial and ethnic groups in the United States. No major differences among racial and ethnic groups in the predictive value of calcium scores were detected.Copyright 2008 Massachusetts Medical Society.

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