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Background  Coronary artery calcium ( CAC ) predicts coronary heart disease ( CHD ) events better than carotid wall plaque presence; however, differences in the utility of  CAC  burden and carotid plaque burden across the spectrum of cardiovascular disease ( CVD ) events is unknown.    Methods and Results   CVD ,  CHD  and stroke/transient ischemic attack ( TIA ) events were evaluated prospectively in a multiethnic cohort without  CVD  at baseline. Carotid plaque score was determined by the number of ultrasound‐detected plaques in the common, bifurcation, and internal carotid artery segments.  CAC  was detected by computed tomography. Predictive values were compared using Cox proportional hazards models, C‐statistics, and net reclassification, adjusting for traditional  CVD  risk factors. At baseline, the 4955 participants were mean (SD) 61.6 (10.1) years old and 52.8% female; 48.9% had  CAC  >0 and 50.8% had at least 1 carotid plaque. After 11.3 (3.0) years of follow‐up, 709  CVD , 498  CHD , and 262 stroke/ TIA  events occurred.  CAC  score compared to carotid plaque score was a stronger predictor of  CVD  (hazard ratio [ HR ], 1.78; 95%  CI , 1.16–1.98;  P <0.001 vs  HR , 1.27; 95%  CI , 1.16–1.40;  P <0.001) and  CHD  events ( HR , 2.09; 95%  CI , 1.84–2.38;  P <0.001 vs  HR , 1.35; 95%  CI , 1.21–1.51;  P <0.001).  CAC  score and carotid plaque score were weak predictors of stroke/ TIA .  CAC  score had better reclassification statistics than carotid plaque score, except for stroke/ TIA , which had similar predictive values.    Conclusions   CAC  score improved prediction, discrimination, and reclassification of  CVD  and  CHD  better than carotid ultrasound measures, although prediction and discrimination were similar for stroke/ TIA .

journal of the american heart association

Comparison of Carotid Plaque Score and Coronary Artery Calcium Score for Predicting Cardiovascular Disease Events: The Multi‐Ethnic Study of Atherosclerosis