142nd APHA Annual Meeting and Exposition

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Predictors of coronary artery calcium and its relationship with traditional and behavioral risk factors for coronary artery disease among rural population

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Monday, November 17, 2014

Hadii M. Mamudu, PhD, MPA , Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN
Timir Paul, MD, PhD , Cardiac Rehabilitation and Prevention, East Tennessee State University, Quillen College of Medicine, Johnson City, TN
Sreenivas P. Veeranki, MBBS, DrPH, MPH , Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
Xuefeng Liu, PhD , Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN
Matthew Budoff, MD, Professor , Los Angeles Biomedical Research Institute, Torrance, CA
Terri Walker , Wellmont CVA Heart Institute, Kingsport, TN
Liang Wang, MD, DrPH, MPH , Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN
Xiaohui Guo, BSc , Biology, East Tennessee State university, Johnson City, TN
Paige Thornton, MPH Studen , Depart of Community and Behavioral Health, East Tennessee State University, Johnson City, TN
Background: Coronary artery calcium (CAC), detected by computed tomography (CT), is a sub-clinical marker for coronary artery disease (CAD), the commonest form of cardiovascular disease (CVD), that predicts risk of future coronary events among asymptomatic individuals with high prognostic significance. This study aims to investigate the prevalence of CAC and its association with traditional and psychosocial risk factors of CAD in Central Appalachian.

Methods:  During 2011 to 2012, CAC was assessed by CT among asymptomatic individuals (n=1724) from Eastern Tennessee, Southwest Virginia, South Kentucky and Southwest North Carolina at a tertiary heart institute. Participants were self- or physician-referred and males aged 45-75 years and females aged 55-75 years were included in this study. Using standardized method, CAC scores were stratified as no (CAC = 0), mild (CAC = 0-99), moderate (CAC = 100-399), and high (CAC ≥ 400). Data on demographics (age, gender, race/ethnicity), lifestyle (smoking, obesity, sedentary), medical conditions (diabetes, hypertension, dyslipidemia), and history of coronary artery disease (personal, family) were collected. Descriptive analyses were conducted to assess prevalence and magnitude of CAC and multivariate analyses to delineate key predictors of CAC in this rural population.

Results: Of 1724 asymptomatic individuals, 768 (44.6%) have no CAC. Of those with CAC (n=956), 511 (53.5%) had mild CAC, 261(27.3%) had moderate CAC, and 184 (19.2%) had high CAC. Overall, higher CAC scores were significantly associated with age, gender, diabetes, smoking, and BMI (p < 0.05). Compared with males, females were about 5 times more likely to have CAC (OR=4.76, 95% CI=3.70-6.12). Individuals with diabetes (OR=1.61, 95% CI=1.13-2.29), family history (OR=1.43, 95% CI=1.12-1.83), hypertension (OR=1.62, 95% CI=1.28-2.05), smoking (OR=1.64, 95% CI=1.30-2.08) were at higher likelihood of having CAC. When stratified by gender, age, smoking and BMI were associated with higher CAC score in males, while age, smoking, and diabetes for females.

Conclusion: This study shows that the severity of CAC within this study population was primarily determined by lifestyle factors. While these results reinforce findings of existing studies, this study is particularly important because the participants were from an area in the United States where the prevalence of smoking and obesity is above the national average.  Therefore, early detection of subclinical coronary atherosclerosis is of paramount importance in this high CVD prevalence area to prevent CAD events, by facilitating lifestyle modification and implementing effective educational and preventive measures/programs.

Learning Areas:

Chronic disease management and prevention
Clinical medicine applied in public health
Conduct evaluation related to programs, research, and other areas of practice

Learning Objectives:
Evaluate the prevalence of coronary artery calcium among asymptomatic patients of a tertiary heart institute Analyze predictors of coronary artery calcium among a population from predominantly rural area Provide information that could inform policy and behavioral changes among a population from an area with higher prevalence of cardiovascular disease, obesity and tobacco use

Keyword(s): Heart Disease, Chronic Disease Prevention

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am an Assistant Professor in Public Health. I am involved in a collaborative research relationship with a hospital system in Northeast Tennessee, where assessments of coronary artery calcium, a subclinical marker for coronary artery disease, are performed.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 3202.0: Poster session: Rural health