Online Program

Impact of clusters of risk factors on subclinical coronary artery disease among asymptomatic rural population

Tuesday, November 3, 2015

Kamrie Sarnosky, MPH Student, East Tennessee State University, Johnson City, TN
Hadii 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
Liang Wang, MD, DrPH, MPH, Department of Biostatistics and Epidemiology, College of Public Health, College of Public Health, East Tennessee State University, Johnson City, TN
Sreenivas P. Veeranki, MBBS, DrPH, Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX
Hemang Panchal, MD, MPH, Internal Medicine, East Tennessee State University, Johnson City, TN
Matthew Budoff, MD, Professor, Los Angeles Biomedical Research Institute, Torrance, CA
Background: Although global risk assessment scores based on traditional cardiovascular risk factors are used to stratify the risk for coronary artery disease (CAD), a significant number of asymptomatic middle-aged adults experience coronary events without prior symptoms. Thus, it is important to early identify asymptomatic adults using subclinical markers of CAD such as  coronary artery calcium (CAC) to overcome such limitation.  However, there is near absence of research on CAC in Central Appalachia, a predominantly rural region, despite the potential to foster early detection and treatment of CAD and to motivate asymptomatic individuals towards beneficial behavioral and lifestyle changes. Therefore, we aimed to assess the impact of clusters of risk factors on CAC score, a measure of severity of CAD, to guide local and regional  clinical practice and formulate policies and programs to address the high prevalence of cardiovascular diseases  in the region.

Methods: The study included 1607 asymptomatic individuals from Central Appalachia who participated in screening for CAC scores between January 2011 and December 2012.   Self-reported data on demographics and 7 risk factors (obesity, diabetes, hypercholesterolemia, hypertension, smoking, sedentary lifestyle, and family history of CAD) were categorized into three clusters of risk factors (<3, 3-5, and >5) for the analysis. We examined the mean CAC scores by cluster and delineated the impact of clusters of risk factors on CAC score using multiple logistic regression.


Results: Of the participants in the CAC screening, the majority (98.3%) had at least one risk factor. Regardless of gender, the number of risk factors was significantly positively correlated with the mean CAC score (p<0.0001).  Overall, the mean CAC score was 93.1, 183.4, and 405.7 for those with <3, 3-5, and >5 risk factors, respectively (p<0.0001). After adjusting for gender and age, clusters of 3-5 and >5 risk factors were significantly associated with increased odds of having CAC by approximately two times [OR=1.92; 95% CI (1.52-2.42)] and six times [OR=6.12, 95% CI (3.05-12.29)], respectively.

Conclusion: Among this rural population, the number of clusters of risk factors was positively associated with higher CAC scores. This may indicate that the number of risk factors may help in determining the severity of CAD in this population before it progresses further to the extent when individuals develop symptoms or have cardiovascular events. This suggests the importance of primary prevention by aggressive risk factors modification for preventing future CAD and subsequent coronary events in these asymptomatic individuals.

Learning Areas:

Basic medical science applied in public health
Chronic disease management and prevention

Learning Objectives:
Evaluate the correlations between risk factors and coronary artery calcium (CAC) scores Determine the clustering of the risk factors across age and gender

Keyword(s): Risk Factors/Assesment, Rural Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am part on a CVD research group that conduct studies on coronary artery calcium (CAC) using populations in Central Appalachia.
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.