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In asymptomatic patients aged 45 to 84 years, coronary artery calcium appears better than carotid intima-media thickness for predicting cardiovascular events, according to a report.

As Dr. Aaron R. Folsom told Reuters Health, if physicians "want to consider a subclinical measure in those of intermediate risk, because it will impact preventive therapy, then CAC seems to be better than IMT in middle-aged persons."

Dr. Folsom from the University of Minnesota, Minneapolis, and colleagues in the Multi-Ethnic Study of Atherosclerosis (MESA) assessed the potential utility of measuring CAC versus carotid IMT for global cardiovascular disease risk prediction using data from 6698 adults who participated in MESA.

After adjustment for traditional risk factors, "the hazard ratio of cardiovascular disease increased 2.1-fold for each one-standard deviation increment of log-transformed CAC score, vs 1.3-fold for each 1-SD increment of the maximum IMT," the researchers found.

Findings were similar when the analysis was restricted to patients at intermediate risk of cardiovascular disease, the investigators say.

"Although previous consensus statements indicated that CAC score and IMT are global atherosclerosis measures and either might be used clinically for refinement of cardiovascular disease risk assessment, our data suggest that in asymptomatic 45- to 84-year-old US adults, CAC score may be the better choice over IMT," the researchers conclude.

"Even within the asymptomatic group, we only recommend consideration of one of these tests and only in those of intermediate risk based on standard risk factors," Dr. Folsom explained. "Within that group, one would need to consider availability of each test and whether there might be a family history of stroke - both of these might make one pick IMT."

"New aspects we are looking at are whether cardiovascular disease genetic markers add to risk prediction," Dr. Folsom added.

Arch Intern Med 2008;168:1333-1339