Calcificações na aorta torácica e nas artérias coronárias: associações com os fatores de risco cardiovascular em participantes do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil) em Minas Gerais

Abstract

Thoracic aortic calcium (TAC) and coronary artery calcium (CAC) are associated with an increased risk of cardiovascular disease (CVD) and death. However, risk factors associated with arterial calcium may vary across vascular beds. We verified whether TAC is associated with the cardiovascular (CV) risk factors as is CAC in adults without established CVD, and compared the associations between the same risk factors to each segment of thoracic aorta (ascending, aortic arch, and descending portions). Cross-sectional analysis including 2,433 participants (aged 38 to 78 years) of ELSA-Brasil cohort in Minas Gerais. Nonenhanced ECG-gated multislice computed tomography were performed to detect calcium in the thoracic aorta and in the coronaries (2015 to 2016). Multivariate logistic regression evaluated the associations of both TAC, total and by segment, and CAC with CV risk factors (smoking, body mass index [BMI], physical activity, alcohol intake, family history of CVD, low-density lipoprotein- and high-density lipoprotein-cholesterol, HbA1c, blood pressure, antidiabetic, antihypertensive, and lipid lowering medications). Overall prevalence of TAC and CAC were 69% and 43%, respectively. CAC prevalence was lower among women (31%) than men (56%). After adjustments, black individuals were less likely to have any CAC as compared with whites. Neither sex, nor race/skin color were statistically associated with TAC. Use of antidiabetic medications remained associated with CAC, but not with TAC. Regarding to aortic segments, the higher prevalence of calcium was in the aortic arch (62%), followed by the descending (31%), and ascending portions (23%). Although the calcium distribution along the aorta is very heterogeneous, there were small differences between the associations of risk factors and each segment of thoracic aorta. There were no significant differences related to gender and race/skin color in any studied segment. Increasing age, lower scholarities levels, smoking, arterial hypertension, and higher BMI remained associated with calcium in all segments. In conclusion, CAC and TAC had differences in the associations with risk factors, mainly related to gender and race/skin color. Moreover, the heterogeneous distribution of calcium along the aorta did not affected the associations between the cardiovascular risk factors and each segment, since the associations shared many similarities among the aortic segments.