Abstract Body: Introduction: The Agatston score is a measure of coronary artery calcification (CAC) used to predict atherosclerotic cardiovascular disease (ASCVD) events. Notably, the score is upweighted for calcium density, despite evidence that density is inversely associated with cardiovascular disease after accounting for volume. Some studies have found associations between dietary components and the Agatston score, but none have evaluated diet in relation to CAC density and volume.
Hypothesis: The Alternative Healthy Eating Index-2010 (AHEI), a measure of diet quality, is associated with lower CAC volume and higher CAC density.
Methods: During the baseline exam of the Multi-Ethnic Study of Atherosclerosis, diet was assessed with a 120-item food frequency questionnaire from which the AHEI was derived. At the same exam, CAC was measured from computed tomography scans. In 3,099 participants with non-zero CAC volume, we modeled the associations of AHEI and natural log of Agatston score, natural log of volume, and density with linear regression. Models adjusted for age, sex, race/ethnicity, education, energy intake, cigarette smoking, and physical activity. We further adjusted for volume when density was the outcome and density when volume was the outcome.
Results: The analytic sample included non-Hispanic White (45%), Black (23%), Hispanic (20%) and Chinese American (12%) individuals (mean age 66 years; 42% female). The median (Q1, Q3) Agatston score was 88 (22, 299) and volume was 85 mm³ (25, 277). The mean (standard deviation [SD]) density score was 2.8 (0.7). After adjustment, the association of a one SD higher AHEI and Agatston score was not statistically significant (95% confidence interval [CI]: -0.10, 0.02; p=0.24). Conversely, in models assessing the relationship of AHEI with volume and density independent of one another, associations were significant (p=0.02 for volume; p=0.02 for density). A one SD higher AHEI was associated with a 0.05-unit lower log of volume (95% CI: -0.10, -0.01) and 0.02-unit higher density (95% CI: 0.00, 0.04).
Conclusions: Our finding that higher AHEI was associated with lower CAC volume and higher CAC density aligns with research showing that diet is a risk factor for ASCVD. The null association with Agatston score appears to reflect the cancelling effects of the positive associations of density with higher AHEI and volume with lower AHEI, rather than the absence of a potential impact of dietary intake on subclinical atherosclerosis.