JACC: Cardiovascular Imaging
Sex Differences in Coronary Artery and Thoracic Aorta Calcification and Their Association With Cardiovascular Mortality in Heavy Smokers
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Author + information
- Nikolas Lessmann, MSca,∗ (n.lessmann{at}umcutrecht.nl),
- Pim A. de Jong, MD, PhDb,c,
- Csilla Celeng, MD, PhDb,
- Richard A.P. Takx, MD, MSc, PhDb,d,
- Max A. Viergever, PhDa,c,
- Bram van Ginneken, PhDe and
- Ivana Išgum, PhDa
- aImage Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
- bDepartment of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
- cUtrecht University, Utrecht, the Netherlands
- dDepartment of Radiology, St. Antonius Hospital, Nieuwegein, the Netherlands
- eDiagnostic Image Analysis Group, Radboud University Medical Center, Nijmegen, the Netherlands
- ↵∗Address for correspondence:
Dr. Nikolas Lessmann, University Medical Center Utrecht, Postbus 85500, Room Q.02.4.45, 3508 GA Utrecht, the Netherlands.
Graphical abstract
Abstract
Objectives The aim of this study was to investigate sex differences in the prevalence, extent, and association of coronary artery calcium (CAC) and thoracic aorta calcium (TAC) scores with cardiovascular mortality in a population eligible for lung screening.
Background CAC and TAC scores derived from chest computed tomography (CT) might be useful biomarkers for individualized cardiovascular disease prevention and could be especially relevant in high-risk populations such as heavy smokers. Therefore, it is important to know the prevalence of arterial calcifications in male and female heavy smokers, and if there are differences in the predictive value calcifications carry.
Methods We performed a nested case–control study with 5,718 participants of the CT arm of the NLST (National Lung Screening Trial). Prevalence and extent of CAC and TAC were resampled to the full cohort to provide unbiased estimates of the typical calcium burden of male and female heavy smokers. Weighted Cox proportional hazards regression was used to assess differences in the association of CAC and TAC scores with all-cause and cardiovascular mortality.
Results CAC was substantially more common and more severe in men (prevalence: 81% vs. 60%; median volume: 104 mm³ vs.12 mm³). Women had CAC comparable to that of men who were 10 years younger. TAC was equally common in men and women, with a tendency to be more pronounced in women (prevalence: 92% vs. 93%; median volume: 388 mm³ vs. 404 mm³). Both types of calcification were associated with increased cardiovascular and all-cause mortality. TAC scores improved the prediction of coronary heart disease mortality over CAC in men, but not in women. In both sexes, TAC, but not CAC, was associated with cardiovascular mortality other than coronary heart disease.
Conclusions CAC develops later in women, whereas TAC develops equally in both sexes. CAC is strongly associated with coronary heart disease, whereas TAC is especially associated with extracardiac vascular mortality in either sex.
- cardiovascular disease
- coronary artery calcium
- lung cancer screening
- sex differences
- thoracic aorta calcium
Footnotes
Drs. Išgum and Viergever were supported by an institutional research grant from PIE Medical Imaging and a research grant from the Netherlands Organization for Health Research and Development (ZonMw) in the framework of the research program IMDI (Innovative Medical Devices; 104003009), awarded with participation of Pie Medical Imaging. Drs. Išgum, van Ginneken, and Viergever were supported by a research grant from the Dutch Technology Foundation (STW) within the Deep Learning for Medical Image Analysis (DLMedIA) program, awarded with participation of PIE Medical Imaging, Philips Healthcare, Thirona, ScreenPoint Medical, and Delft Imaging Systems (P15-26). Drs. Išgum, de Jong, and Viergever were supported by a research grant from the Dutch Technology Foundation (STW) within the Population Imaging Genetics (ImaGene) program, awarded with participation of PIE Medical Imaging and 3mensio Medical Imaging (12726).
Dr. van Ginneken is co-founder and stockholder of Thirona; and has received royalties and research funding from Thirona, MeVis Medical Solutions, and Delft Imaging Systems. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 8, 2018.
- Revision received October 9, 2018.
- Accepted October 12, 2018.
- 2019 American College of Cardiology Foundation
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