Prevalence of thoracic aortic calcification and its relationship to cardiovascular risk factors and coronary calcification in an unselected population-based cohort: the Heinz Nixdorf Recall Study

  • Hagen KälschEmail author
  • Nils Lehmann
  • Stefan Möhlenkamp
  • Cornelia Hammer
  • Amir A. Mahabadi
  • Susanne Moebus
  • Axel Schmermund
  • Andreas Stang
  • Marcus Bauer
  • Karl-Heinz Jöckel
  • Raimund Erbel
  • On behalf of the Investigator Group of the Heinz Nixdorf Recall Study
Original Paper


Thoracic aortic calcification (TAC) and coronary artery calcium (CAC) have been proposed for risk assessment of coronary artery and cardiovascular disease events. The aim of this analysis is to assess the prevalence of TAC and to determine its relationship with cardiovascular risk factors and CAC in a general unselected population. TAC was measured from electron beam computed tomography scans and quantified by Agatston-Score in 4,025 participants aged 45–75 years (mean age 59.4 ± 7.8 years, 53 % female) from the Heinz Nixdorf Recall Study. Multivariable generalized linear regression was used to evaluate relationships between TAC and cardiovascular risk factors and CAC. Overall 2,538/4,025 (63.1 %) participants revealed TAC. Prevalence of TAC was greater in men than in women (65.2 vs. 61.7 %, p = 0.009). TAC was most strongly associated with age, systolic blood pressure, smoking and high levels of LDL-cholesterol. Prevalence of CAC was significantly higher in participants with TAC than without (74.0 vs. 57.6 %, p < 0.0001) demonstrating an increased risk of having CAC in the presence of TAC (prevalence ratio (PR) 1.29 [95 % CI: 1.22–1.35], p < 0.0001, PR adjusted for risk factors 1.14 [1.09–1.20], p < 0.0001). In general population, TAC has high prevalence and largely shares cardiovascular risk factors with CAD while being independently associated with present CAC.


Thoracic aortic calcification Coronary artery calcium Computed tomography 



We thank the Heinz Nixdorf Foundation, Germany, for their generous support of this study. This study is also supported by the German Ministry of Education and Science (BMBF), and the German Aerospace Center (Deutsches Zentrum für Luft- und Raumfahrt (DLR)), Bonn, Germany. We thank Prof. Dr. K. Lauterbach (Dept. of Health Economy and Epidemiology, University of Cologne, Germany) for his valuable contributions in an early phase of the study. The authors thank the participants of the Heinz Nixdorf Recall study and the entire community of Heinz Nixdorf Recall investigators and staff for their support and valuable contributions.

Conflict of interest

None of the authors have declared a conflict of interest or financial disclosures.


  1. 1.
    Witteman JC, Kannel WB, Wolf PA et al (1990) Aortic calcified plaques and cardiovascular disease (the Framingham Study). Am J Cardiol 66:1060–1064PubMedCrossRefGoogle Scholar
  2. 2.
    Witteman JC, Kok FJ, van Saase JL et al (1986) Aortic calcification as a predictor of cardiovascular mortality. Lancet 2:1120–1122PubMedCrossRefGoogle Scholar
  3. 3.
    Takasu J, Mao S, Budoff MJ (2003) Aortic atherosclerosis detected with electron-beam CT as a predictor of obstructive coronary artery disease. Acad Radiol 10:631–637PubMedCrossRefGoogle Scholar
  4. 4.
    Agmon Y, Khandheria BK, Meissner I et al (2002) Relation of coronary artery disease and cerebrovascular disease with atherosclerosis of the thoracic aorta in the general population. Am J Cardiol 89:262–267PubMedCrossRefGoogle Scholar
  5. 5.
    Elias-Smale SE, Odink AE, Wieberdink RG et al (2010) Carotid, aortic arch and coronary calcification are related to history of stroke: the Rotterdam Study. Atherosclerosis. 212(2):656–660PubMedCrossRefGoogle Scholar
  6. 6.
    Budoff MJ, Nasir K, Katz R et al (2011) Thoracic aortic calcification and coronary heart disease events: the multi-ethnic study of atherosclerosis (MESA). Atherosclerosis 215(1):196–202PubMedCrossRefGoogle Scholar
  7. 7.
    Erbel R, Alfonso F, Boileau C et al (2001) Task force on aortic dissection of the European Society of Cardiology. Diagnosis and management of aortic dissection. Eur Heart J 22(1642–81):5Google Scholar
  8. 8.
    McClelland RL, Chung H, Detrano R, Post W, Kronmal RA (2006) Distribution of coronary artery calcium by race, gender, and age: results from the Multi-Ethnic Study of Atherosclerosis (MESA). Circulation 113:30–37PubMedCrossRefGoogle Scholar
  9. 9.
    Wong ND, Hsu JC, Detrano RC et al (2000) Coronary artery calcium evaluation by electron beam computed tomography and its relation to new cardiovascular events. Am J Cardiol 86(5):495–498PubMedCrossRefGoogle Scholar
  10. 10.
    Greenland P, LaBree L, Azen SP et al (2004) Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. JAMA 291(2):210–215PubMedCrossRefGoogle Scholar
  11. 11.
    Detrano R, Guerci AD, Carr JJ et al (2008) Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med 358(13):1336–1345PubMedCrossRefGoogle Scholar
  12. 12.
    Erbel R, Möhlenkamp S, Moebus S et al (2010) Heinz Nixdorf Recall Study Investigative Group. Coronary risk stratification, discrimination, and reclassification improvement based on quantification of subclinical coronary atherosclerosis: the Heinz Nixdorf Recall study. J Am Coll Cardiol 56(17):1397–1406PubMedCrossRefGoogle Scholar
  13. 13.
    Budoff MJ, Shaw LJ, Liu ST et al (2007) Long-term prognosis associated with coronary calcification: observations from a registry of 25,253 patients. J Am Coll Cardiol 49(18):1860–1870PubMedCrossRefGoogle Scholar
  14. 14.
    Budoff MJ, Achenbach S, Blumenthal RS et al (2006) Assessment of coronary artery disease by cardiac computed tomography. Circulation 114(16):1761–1791PubMedCrossRefGoogle Scholar
  15. 15.
    Takasu J, Katz R, Nasir K et al (2008) Relationships of thoracic aortic wall calcification to cardiovascular risk factors: the Multi-Ethnic Study of Atherosclerosis (MESA). Am Heart J 155(4):765–771PubMedCrossRefGoogle Scholar
  16. 16.
    Bild DE, Bluemke DA, Burke GL et al (2002) Multi-ethnic study of atherosclerosis: objectives and design. Am J Epidemiol 156:871–881PubMedCrossRefGoogle Scholar
  17. 17.
    Bild DE, Detrano R, Peterson D et al (2005) Ethnic differences in coronary calcification. The Multi-Ethnic Study of Atherosclerosis (MESA). Circulation 111:1313–1320PubMedCrossRefGoogle Scholar
  18. 18.
    Takasu J, Budoff MJ, O’Brien KD et al (2009) Relationship between coronary artery and descending thoracic aortic calcification as detected by computed tomography: the Multi-Ethnic Study of Atherosclerosis. Atherosclerosis 204(2):440–446PubMedCrossRefGoogle Scholar
  19. 19.
    Schmermund A, Möhlenkamp S, Stang A et al (2002) Heinz Nixdorf Recall Study Investigative Group. Assessment of clinically silent atherosclerotic disease and established and novel risk factors for predicting myocardial infarction and cardiac death in healthy middle-aged subjects: rationale and design of the Heinz Nixdorf Recall study. Am Heart J 144:212–218PubMedCrossRefGoogle Scholar
  20. 20.
    Möhlenkamp S, Moebus S, Schmermund A et al (2007) Assessment of the natural history of coronary artery calcification and identification of its determinants. Rationale of the 2nd part of the Heinz Nixdorf Recall Study. Herz 32(2):108–120PubMedCrossRefGoogle Scholar
  21. 21.
    Schmermund A, Lehmann N, Bielak LF et al (2007) Comparison of subclinical coronary atherosclerosis and risk factors in unselected populations in Germany and US-America. AtherosclerosisGoogle Scholar
  22. 22.
    Schmermund A, Mohlenkamp S, Berenbein S et al (2006) Population-based assessment of subclinical coronary atherosclerosis using electron-beam computed tomography. Atherosclerosis 185(1):177–182PubMedCrossRefGoogle Scholar
  23. 23.
    Stang A, Moebus S, Möhlenkamp S et al (2006) Heinz Nixdorf Recall Study Investigative Group. Algorithms for converting random-zero to automated oscillometric blood pressure values, and vice versa. Am J Epidemiol 164:85–94PubMedCrossRefGoogle Scholar
  24. 24.
    Erbel R, Möhlenkamp S, Lehmann N et al (2008) Heinz Nixdorf Recall Study Investigative Group. Sex related cardiovascular risk stratification based on quantification of atherosclerosis and inflammation. Atherosclerosis 197:662–672PubMedCrossRefGoogle Scholar
  25. 25.
    Agatston AS, Janowitz WR, Hildner FJ et al (1990) Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 15:827–832PubMedCrossRefGoogle Scholar
  26. 26.
    Wong ND, Sciammarella M, Arad Y et al (2003) Relation of thoracic aortic and aortic valve calcium to coronary artery calcium and risk assessment. Am J Cardiol 92(8):951–955PubMedCrossRefGoogle Scholar
  27. 27.
    Erbel R, Delaney JA, Lehmann N et al (2008) Multi-Ethnic Study of Atherosclerosis; Investigator Group of the Heinz Nixdorf Recall Study. Signs of subclinical coronary atherosclerosis in relation to risk factor distribution in the Multi-Ethnic Study of Atherosclerosis (MESA) and the Heinz Nixdorf Recall Study (HNR). Eur Heart J 29(22):2782–2791PubMedCrossRefGoogle Scholar
  28. 28.
    Itani Y, Watanabe S, Masuda Y (2004) Aortic calcification detected in a mass chest screening program using a mobile helical computed tomography unit. Relationship to risk factors and coronary artery disease. Circ J 68:538–541PubMedCrossRefGoogle Scholar
  29. 29.
    Budoff MJ, Nasir K, McClelland RL et al (2009) Coronary calcium predicts events better with absolute calcium scores than age-, sex-, race/ethnicity percentiles: MESA (multi-ethnic study of atherosclerosis). J Am Coll Cardiol 53:345–352PubMedCrossRefGoogle Scholar
  30. 30.
    Detrano R, Anderson M, Nelson J et al (2005) Coronary calcium measurements: effect of CT scanner type and calcium measure on rescan reproducibility—MESA study. Radiology 236:477–484PubMedCrossRefGoogle Scholar
  31. 31.
    Wong ND, Gransar H, Shaw L et al (2009) Thoracic aortic calcium versus coronary artery calcium for the prediction of coronary heart disease and cardiovascular disease events. JACC Cardiovasc Imaging 2(3):319–326PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, B.V. 2012

Authors and Affiliations

  • Hagen Kälsch
    • 1
    Email author
  • Nils Lehmann
    • 2
  • Stefan Möhlenkamp
    • 1
  • Cornelia Hammer
    • 1
  • Amir A. Mahabadi
    • 1
  • Susanne Moebus
    • 2
  • Axel Schmermund
    • 3
  • Andreas Stang
    • 4
  • Marcus Bauer
    • 1
  • Karl-Heinz Jöckel
    • 2
  • Raimund Erbel
    • 1
  • On behalf of the Investigator Group of the Heinz Nixdorf Recall Study
  1. 1.West-German Heart Center Essen, Department of CardiologyUniversity Clinic Duisburg-EssenEssenGermany
  2. 2.Institute of Medical Informatics, Biometry, and EpidemiologyUniversity Duisburg-EssenEssenGermany
  3. 3.Cardioangiological Center BethanienFrankfurtGermany
  4. 4.Medical Faculty, Institute of Clinical EpidemiologyUniversity Halle-WittenbergHalleGermany

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