Evidence map›Paper›PMID 34879218›Full record

ArticleCirculation2022

Determinants of Incident Atherosclerotic Cardiovascular Disease Events Among Those With Absent Coronary Artery Calcium: Multi-Ethnic Study of Atherosclerosis.

Mahmoud Al Rifai, Michael J Blaha, Vijay Nambi, Steven J C Shea, Erin D Michos, Roger S Blumenthal, Christie M Ballantyne, Moyses Szklo, Philip Greenland, Michael D Miedema and 6 more

Open access · bronzeAbstract read
In one paragraph

Article in Circulation, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
24citing papers in PubMed, 1 pooled it
4.6field-weighted citation impact, top 4% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

24 citing papers in PubMed, 1 synthesis or guideline pooled it, 37 citations in OpenAlex.

  1. Pooled it
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  12. Type of evidence supporting ACC/AHA and ESC clinical practice guidelines for acute coronary syndrome.Clinical research in cardiology : official journal of the German Cardiac Society · 2024
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors at 8 institutions in 1 country.

Mahmoud Al RifaiSection of Cardiology, Baylor College of Medicine, Houston, TX (M.A.R., V.N., C.M.B., S.S.V.).ORCID 0000-0002-6933-790X
Michael J BlahaThe Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University, Baltimore, MD (M.J.B., E.D.M., R.S.B., W.S.P.).ORCID 0000-0001-5138-9683
Vijay NambiSection of Cardiology, Baylor College of Medicine, Houston, TX (M.A.R., V.N., C.M.B., S.S.V.).ORCID 0000-0002-4237-0267
Steven J C SheaDepartments of Medicine and Epidemiology, Columbia University, New York, NY (S.J.C.S.).ORCID 0000-0002-7382-0603
Erin D MichosThe Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University, Baltimore, MD (M.J.B., E.D.M., R.S.B., W.S.P.).ORCID 0000-0002-5547-5084
Roger S BlumenthalThe Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University, Baltimore, MD (M.J.B., E.D.M., R.S.B., W.S.P.).ORCID 0000-0003-1910-3168
Christie M BallantyneSection of Cardiology, Baylor College of Medicine, Houston, TX (M.A.R., V.N., C.M.B., S.S.V.).ORCID 0000-0002-6432-1730
Moyses SzkloDepartment of Epidemiology, Bloomberg School of Public Health, Baltimore, MD (M.S.).
Philip GreenlandDepartments of Preventive Medicine and Medicine, Northwestern University Feinberg School of Medicine, Chicago IL (P.G.).ORCID 0000-0002-6327-2439
Michael D MiedemaMinneapolis Heart Institute and Minneapolis Heart Institute Foundation, MN (M.D.M.).
Khurram NasirDivision of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, TX (K.N.).ORCID 0000-0001-5376-2269
Jerome I RotterSection of Cardiology, Baylor College of Medicine, Houston, TX (M.A.R., V.N., C.M.B., S.S.V.).ORCID 0000-0001-7191-1723
Xiuqing GuoInstitute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA (X.G., J.Y.).ORCID 0000-0002-5264-5068
Jie YaoInstitute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA (X.G., J.Y.).ORCID 0000-0002-8822-0651
Wendy S PostThe Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University, Baltimore, MD (M.J.B., E.D.M., R.S.B., W.S.P.).ORCID 0000-0002-8655-5204
Salim S ViraniSection of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX (V.N., S.S.V.).ORCID 0000-0001-9541-6954
Johns Hopkins University · USBaylor College of Medicine · USMichael E. DeBakey VA Medical Center · USUCLA Medical Center · USColumbia University · USHouston Methodist · USMinneapolis Heart Institute Foundation · USNorthwestern University · US

Funding

UCLA Clinical Translational Science InstituteUL1TR001881 · NCATS · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI ARLEEN F. BROWN, ARASH NAEIM · 2016 to 2026
$118.1M
Institute for Clinical and Translational ResearchUL1TR001079 · NCATS · JOHNS HOPKINS UNIVERSITY · PI FORD, DANIEL ERNEST · 2013 to 2017
$60.1M
QAQC Johns Hopkins Institute for Clinical and Translational ResearchUL1TR003098 · NCATS · JOHNS HOPKINS UNIVERSITY · PI FORD, DANIEL ERNEST · 2019 to 2023
$57.7M
Transgenic & Knock-out MouseP30DK063491 · NIDDK · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI ALAN R. SALTIEL · 2003 to 2026
$40.4M
Wake Forest Clinical and Translational Science AwardUL1TR001420 · NCATS · WAKE FOREST UNIVERSITY HEALTH SCIENCES · PI ARD, JAMY D, FOLEY, KRISTIE L · 2015 to 2023
$32.3M
Clinical and Translational Science AwardUL1TR000040 · NCATS · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI GINSBERG, HENRY N · 2012 to 2015
$26.2M
Task Area A Core Study Operations.Task Area A shall encompass annual follow-up of cohort members, clinical endpoints ascertainment, study coordination activities, maintenance of the database and biosp75N92020D00001 · NHLBI · UNIVERSITY OF WASHINGTON · PI MCCLELLAND, ROBYN LEAGH · 2020 to 2025
$17.2M
Task Area A shall encompass annual follow-up of cohort members, clinical events investigations, study operations, and data analysis and manuscript writing. If implemented, Task A.1 will provide fundin75N92020D00005 · NHLBI · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI WATSON, KAROL E · 2020 to 2025
$5.1M
TO EXERCISE OPTION PERIOD ONE (1) FOR TASK AREA A - MESA CORE OPERATIONS, FIELD CENTER.75N92020D00004 · NHLBI · NORTHWESTERN UNIVERSITY · PI SIEGEL, JONATHAN H · 2020 to 2025
$4.5M
Task Area A shall encompass annual follow-up of cohort members, clinical events investigations, study operations, and data analysis and manuscript writing. If implemented, Task A.1 will provide fundin75N92020D00006 · NHLBI · UNIVERSITY OF MINNESOTA · PI PANKOW, JAMES S · 2020 to 2025
$4.4M
Task Area A shall encompass annual follow-up of cohort members, clinical events investigations, study operations, and data analysis and manuscript writing. If implemented, Task A.1 will provide fundin75N92020D00003 · NHLBI · JOHNS HOPKINS UNIVERSITY · PI POST, WENDY S · 2020 to 2025
$3.8M
Task Area A shall encompass annual follow-up of cohort members, clinical events investigations, study operations, and data analysis and manuscript writing. If implemented, Task A.1 will provide fundin75N92020D00007 · NHLBI · WAKE FOREST UNIVERSITY HEALTH SCIENCES · PI BERTONI, ALAIN GERALD · 2020 to 2025
$3.5M
NCATS NIH HHS UL1 TR000040NCATS NIH HHS UL1 TR001079NCATS NIH HHS UL1 TR001420NCATS NIH HHS UL1 TR001881NCATS NIH HHS UL1 TR003098NHLBI NIH HHS 75N92020D00001NHLBI NIH HHS 75N92020D00002NHLBI NIH HHS 75N92020D00003NHLBI NIH HHS 75N92020D00004NHLBI NIH HHS 75N92020D00005NHLBI NIH HHS 75N92020D00006NHLBI NIH HHS 75N92020D00007NHLBI NIH HHS HHSN268201500003CNHLBI NIH HHS HHSN268201500003INHLBI NIH HHS N01 HC095159NHLBI NIH HHS N01 HC095160NHLBI NIH HHS N01 HC095161NHLBI NIH HHS N01 HC095162NHLBI NIH HHS N01 HC095163NHLBI NIH HHS N01 HC095164NHLBI NIH HHS N01 HC095165NHLBI NIH HHS N01 HC095166NHLBI NIH HHS N01 HC095167NHLBI NIH HHS N01 HC095168NHLBI NIH HHS N01 HC095169NIDDK NIH HHS P30 DK063491
6 · The paper itself

Abstract

backgroundThe 2018 American Heart Association/American College of Cardiology/Multisociety cholesterol guideline states that statin therapy may be withheld or delayed among intermediate-risk individuals in the absence of coronary artery calcium (CAC=0). We evaluated whether traditional cardiovascular risk factors are associated with incident atherosclerotic cardiovascular disease (ASCVD) events among individuals with CAC=0 over long-term follow-up.

methodsWe included participants with CAC=0 at baseline from the MESA (Multi-Ethnic Study of Atherosclerosis), a prospective cohort study of individuals free of clinical ASCVD at baseline. We used multivariable-adjusted Cox proportional hazards models to study the association between cardiovascular risk factors (cigarette smoking, diabetes, hypertension, preventive medication use [aspirin and statin], family history of premature ASCVD, chronic kidney disease, waist circumference, lipid and inflammatory markers) and adjudicated incident ASCVD outcomes.

resultsWe studied 3416 individuals (mean [SD] age 58 [9] years; 63% were female, 33% White, 31% Black, 12% Chinese American, and 24% Hispanic). Over a median follow-up of 16 years, there were 189 ASCVD events (composite of coronary heart disease and stroke) of which 91 were coronary heart disease, 88 were stroke, and 10 were both coronary heart disease and stroke events. The unadjusted event rates of ASCVD were ≤5 per 1000 person-years among individuals with CAC=0 for most risk factors with the exception of current cigarette smoking (7.3), diabetes (8.9), hypertension (5.4), and chronic kidney disease (6.8). After multivariable adjustment, risk factors that were significantly associated with ASCVD included current cigarette smoking: hazard ratio, 2.12 (95% CI, 1.32-3.42); diabetes: hazard ratio, 1.68 (95% CI, 1.01-2.80); and hypertension: hazard ratio, 1.57 (95% CI, 1.06-2.33).

conclusionsCurrent cigarette smoking, diabetes, and hypertension are independently associated with incident ASCVD over a 16-year follow-up among those with CAC=0.

Indexed as

AtherosclerosisCalciumCardiovascular DiseasesCoronary VesselsEthnicityFemaleHumansMaleMiddle AgedRisk FactorsUnited StatesCalciumcarotid artery diseasescoronary artery diseaseheart disease risk factors

Identifiers

PMID34879218
PMCPMC8792296
OpenAlexW4200026926

What Socratic holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.