Progression of calcium density in the ascending thoracic aorta is inversely associated with incident cardiovascular disease events

Isac C. Thomas, Robyn L. McClelland, Matthew A. Allison, Joachim H. Ix, Erin D. Michos, Nketi I. Forbang, Wendy S. Post, Nathan D. Wong, Matthew J. Budoff, Michael H. Criqui

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Aims Little is known regarding the risk of atherosclerotic cardiovascular disease (ASCVD) conferred by changes in the volume and density of ascending thoracic aorta calcium (ATAC) over time. We evaluated changes in ATAC volume and density scores and incident ASCVD events. Methods The Multi-Ethnic Study of Atherosclerosis is a prospective cohort study of individuals without baseline clinical and results ASCVD. Ascending thoracic aorta calcium was measured from baseline and follow-up (mean interval 2.4 years) cardiac computed tomography (CT). Cox proportional hazard regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) per standard deviation for events after the follow-up exam adjusted for ASCVD risk factors, baseline ATAC and coronary artery calcium (CAC) volume and density, and changes in CAC volume and density. Among 5887 participants, 296 (5.0%) had detectable ATAC at baseline, follow-up, or both exams. A total of 403 events occurred over 9.5 years. An increase in ATAC volume was associated with coronary heart disease (CHD) (HR 1.90, 95% CI 1.14–3.16), ASCVD (HR 1.93, 95% CI 1.26–2.94), and ischaemic stroke (HR 2.14, CI 1.21–3.78). An increase in ATAC density was inversely associated with CHD (HR 0.29, 95% CI 0.14–0.60) and ASCVD (HR 0.42, 95% CI 0.23–0.76), but not stroke (HR 0.61, CI 0.23–1.61). Conclusion Ascending thoracic aorta calcium is uncommon on serial cardiac CT. However, changes in ATAC volume and density are both associated with incident ASCVD events, but in opposite directions. Serial assessments in those with baseline ATAC may provide insight into an individual’s trajectory of ASCVD risk.

Original languageEnglish (US)
Pages (from-to)1343-1350
Number of pages8
JournalEuropean heart journal cardiovascular Imaging
Issue number12
StatePublished - Dec 1 2018


  • Ascending aorta
  • Atherosclerosis
  • Atherosclerotic cardiovascular disease
  • Calcification
  • Calcium density

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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