TY - JOUR
T1 - All-cause and cause-specific mortality in individuals with zero and minimal coronary artery calcium
T2 - A long-term, competing risk analysis in the Coronary Artery Calcium Consortium
AU - Blaha, Michael J.
AU - Cainzos-Achirica, Miguel
AU - Dardari, Zeina
AU - Blankstein, Ron
AU - Shaw, Leslee J.
AU - Rozanski, Alan
AU - Rumberger, John A.
AU - Dzaye, Omar
AU - Michos, Erin D.
AU - Berman, Daniel S.
AU - Budoff, Matthew J.
AU - Miedema, Michael D.
AU - Blumenthal, Roger S.
AU - Nasir, Khurram
PY - 2020/2
Y1 - 2020/2
N2 - Background and aims: The long-term associations between zero, minimal coronary artery calcium (CAC) and cause-specific mortality are currently unknown, particularly after accounting for competing risks with other causes of death. Methods: We evaluated 66,363 individuals from the CAC Consortium (mean age 54 years, 33% women), a multi-center, retrospective cohort study of asymptomatic individuals undergoing CAC scoring for clinical risk assessment. Baseline evaluations occurred between 1991 and 2010. Results: Over a mean of 12 years of follow-up, individuals with CAC = 0 (45% prevalence, mean age 45 years) had stable low rates of coronary heart disease (CHD) death, cardiovascular disease (CVD) death (ranging 0.32 to 0.43 per 1000 person-years), and all-cause death (1.38–1.62 per 1000 person-years). Cancer was the predominant cause of death in this group, yet rates were also very low (0.47–0.79 per 1000 person-years). Compared to CAC = 0, individuals with CAC 1–10 had an increased multivariable-adjusted risk of CVD death only under age 40. Individuals with CAC>10 had multivariable-adjusted increased risks of CHD death, CVD death and all-cause death at all ages, and a higher proportion of CVD deaths. Conclusions: CAC = 0 is a frequent finding among individuals undergoing CAC scanning for risk assessment and is associated with low rates of all-cause death at 12 years of follow-up. Our results support the emerging consensus that CAC = 0 represents a unique population with favorable all-cause prognosis who may be considered for more flexible treatment goals in primary prevention. Detection of any CAC in young adults could be used to trigger aggressive preventive interventions.
AB - Background and aims: The long-term associations between zero, minimal coronary artery calcium (CAC) and cause-specific mortality are currently unknown, particularly after accounting for competing risks with other causes of death. Methods: We evaluated 66,363 individuals from the CAC Consortium (mean age 54 years, 33% women), a multi-center, retrospective cohort study of asymptomatic individuals undergoing CAC scoring for clinical risk assessment. Baseline evaluations occurred between 1991 and 2010. Results: Over a mean of 12 years of follow-up, individuals with CAC = 0 (45% prevalence, mean age 45 years) had stable low rates of coronary heart disease (CHD) death, cardiovascular disease (CVD) death (ranging 0.32 to 0.43 per 1000 person-years), and all-cause death (1.38–1.62 per 1000 person-years). Cancer was the predominant cause of death in this group, yet rates were also very low (0.47–0.79 per 1000 person-years). Compared to CAC = 0, individuals with CAC 1–10 had an increased multivariable-adjusted risk of CVD death only under age 40. Individuals with CAC>10 had multivariable-adjusted increased risks of CHD death, CVD death and all-cause death at all ages, and a higher proportion of CVD deaths. Conclusions: CAC = 0 is a frequent finding among individuals undergoing CAC scanning for risk assessment and is associated with low rates of all-cause death at 12 years of follow-up. Our results support the emerging consensus that CAC = 0 represents a unique population with favorable all-cause prognosis who may be considered for more flexible treatment goals in primary prevention. Detection of any CAC in young adults could be used to trigger aggressive preventive interventions.
KW - Cancer
KW - Cardiovascular disease
KW - Competing risks
KW - Coronary artery calcium
KW - Mortality
KW - Risk
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U2 - 10.1016/j.atherosclerosis.2019.11.008
DO - 10.1016/j.atherosclerosis.2019.11.008
M3 - Article
C2 - 31784032
AN - SCOPUS:85079022595
VL - 294
SP - 72
EP - 79
JO - Atherosclerosis
JF - Atherosclerosis
SN - 0021-9150
ER -