TY - JOUR
T1 - Coronary Artery Calcium and the Age-Specific Competing Risk of Cardiovascular Versus Cancer Mortality
T2 - The Coronary Artery Calcium Consortium
AU - Whelton, Seamus P.
AU - Rifai, Mahmoud Al
AU - Marshall, Catherine Handy
AU - Dardari, Zeina
AU - Shaw, Leslee J.
AU - Al-Mallah, Mouaz H.
AU - Rozanski, Alan
AU - Mortensen, Martin B.
AU - Dzaye, Omar
AU - Bazzano, Lydia
AU - Kelly, Tanika N.
AU - Matsushita, Kunihiro
AU - Rumberger, John A.
AU - Berman, Daniel S.
AU - Budoff, Matthew J.
AU - Miedema, Michael D.
AU - Nasir, Khurram
AU - Blaha, Michael J.
N1 - Funding Information:
Funding : SPW was supported by the American Heart Association Mentored Clinical and Population Research Award ( 17MCPRP33660247 ) and the PJ Schafer Memorial Foundation.
Funding Information:
Conflict of Interest: LJS has received grant support from the Antinori Foundation. MJ Budoff has received grant support from GE Healthcare. CHM has received grant support from Bristol Myers Squibb and travel support from DAVA Oncology. She also reports being a consultant for McGraw-Hill. All other authors have nothing to disclose.
Funding Information:
Funding: SPW was supported by the American Heart Association Mentored Clinical and Population Research Award (17MCPRP33660247) and the PJ Schafer Memorial Foundation. Conflict of Interest: LJS has received grant support from the Antinori Foundation. MJ Budoff has received grant support from GE Healthcare. CHM has received grant support from Bristol Myers Squibb and travel support from DAVA Oncology. She also reports being a consultant for McGraw-Hill. All other authors have nothing to disclose.
Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2020/10
Y1 - 2020/10
N2 - Background: Coronary artery calcium (CAC) is a guideline recommended cardiovascular disease (CVD) risk stratification tool that increases with age and is associated with non-cardiovascular disease outcomes including cancer. We sought to define the age-specific change in the association between CAC and cause-specific mortality. Methods: The Coronary Artery Calcium Consortium includes 59,502 asymptomatic patients age 40-75 without known CVD. Age-stratified mortality rates and parametric survival regression modeling was performed to estimate the age-specific CAC score at which CVD and cancer mortality risk were equal. Results: The mean age was 54±8 years (67% men) and there were 2,423 deaths over a mean 12±3 years follow-up. Among individuals with CAC = 0, cancer was the leading cause of death, with low CVD mortality rates for both younger (40-54 years) 0.2/1,000 person-years and older participants (65-75 years) 1.3/1,000 person-years. When CAC ≥400, CVD was consistently the leading cause of death among younger (71% of deaths) and older participants (56% of deaths). The CAC score at which CVD overtook cancer as the leading cause of death increased exponentially with age and was approximately 115 at age 50 and 380 at age 65. Conclusions: Regardless of age, when CAC = 0 cancer was the leading cause of death and the cardiovascular disease mortality rate was low. Our age-specific estimate for the CAC score at which CVD overtakes cancer mortality allows for a more precise approach to synergistic prediction and prevention strategies for CVD and cancer.
AB - Background: Coronary artery calcium (CAC) is a guideline recommended cardiovascular disease (CVD) risk stratification tool that increases with age and is associated with non-cardiovascular disease outcomes including cancer. We sought to define the age-specific change in the association between CAC and cause-specific mortality. Methods: The Coronary Artery Calcium Consortium includes 59,502 asymptomatic patients age 40-75 without known CVD. Age-stratified mortality rates and parametric survival regression modeling was performed to estimate the age-specific CAC score at which CVD and cancer mortality risk were equal. Results: The mean age was 54±8 years (67% men) and there were 2,423 deaths over a mean 12±3 years follow-up. Among individuals with CAC = 0, cancer was the leading cause of death, with low CVD mortality rates for both younger (40-54 years) 0.2/1,000 person-years and older participants (65-75 years) 1.3/1,000 person-years. When CAC ≥400, CVD was consistently the leading cause of death among younger (71% of deaths) and older participants (56% of deaths). The CAC score at which CVD overtook cancer as the leading cause of death increased exponentially with age and was approximately 115 at age 50 and 380 at age 65. Conclusions: Regardless of age, when CAC = 0 cancer was the leading cause of death and the cardiovascular disease mortality rate was low. Our age-specific estimate for the CAC score at which CVD overtakes cancer mortality allows for a more precise approach to synergistic prediction and prevention strategies for CVD and cancer.
KW - Age
KW - Competing risk
KW - Coronary artery calcium
KW - Risk prediction
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U2 - 10.1016/j.amjmed.2020.02.034
DO - 10.1016/j.amjmed.2020.02.034
M3 - Article
C2 - 32268145
AN - SCOPUS:85085162686
VL - 133
SP - e575-e583
JO - American Journal of Medicine
JF - American Journal of Medicine
SN - 0002-9343
IS - 10
ER -