Associations of the PREVENT Score with coronary artery and thoracic aortic calcification among South Asian Americans

• Thoracic aortic calcification (TAC) is a marker of subclinical atherosclerosis that can be obtained from the same computed tomography scan as coronary artery calcium (CAC). • We report the association of ten-year ASCVD risk using the American Heart Association Predicting Risk of cardiovascular disease Events equation (PREVENT) equation with CAC and TAC. • Higher PREVENT-ASCVD estimated risk was associated with higher TAC in women and higher CAC in men. Among women, TAC was significantly higher than CAC in PREVENT-ASCVD estimated risk scores exceeding 7%. • These findings suggest the potential utility of TAC potential utility of TAC as a tool for identifying subclinical atherosclerosis in women. South Asian populations have a high risk of atherosclerotic cardiovascular disease (ASCVD). Coronary artery calcification (CAC) can guide clinical decision making in patients with intermediate ASCVD risk. Thoracic aortic calcification (TAC) can be measured from the same computed tomography scan, though it is unknown whether TAC may help reclassify ASCVD risk. We conducted a cross-sectional analysis of the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study. Ten-year ASCVD risk was calculated using the American Heart Association Predicting Risk of cardiovascular disease Events equation (PREVENT), categorized as <5%, 5 to <10% or ≥10%. TAC and CAC scores were categorized as 0, 1-99, and ≥100. We determined associations of traditional risk factors with TAC and CAC and used cubic spline functions to examine non-linear associations between PREVENT and TAC and CAC, overall and stratified by gender. Of 960 participants, 59.4% had any CAC, 53.8% had any TAC, and 42.4% had both CAC and TAC. Any TAC and any CAC were each more likely with older age, among men, and in those with hypertension, diabetes, higher LDL-cholesterol, and statin use. Higher PREVENT-ASCVD risk was associated with higher TAC in women and higher CAC in men. Among women, TAC was significantly higher than CAC in PREVENT scores ≥7%. In South Asian US adults, higher PREVENT-ASCVD risk is associated with higher CAC and TAC. TAC burden is higher than CAC among women with PREVENT scores 5 to <10%. Further studies should explore if high TAC is predictive of clinical events.