Coronary Artery Calcium and the Age-Specific Competing Risk of Cardiovascular Versus Cancer Mortality: The Coronary Artery Calcium Consortium

Seamus P. Whelton, Mahmoud Al Rifai, Catherine Handy Marshall, Zeina Dardari, Leslee J. Shaw, Mouaz H. Al-Mallah, Alan Rozanski, Martin B. Mortensen, Omar Dzaye, Lydia Bazzano, Tanika N. Kelly, Kunihiro Matsushita, John A. Rumberger, Daniel S. Berman, Matthew J. Budoff, Michael D. Miedema, Khurram Nasir, Michael J. Blaha

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)e575-e583
JournalAmerican Journal of Medicine
Volume133
Issue number10
DOIs
StatePublished - Oct 2020

Keywords

  • Age
  • Competing risk
  • Coronary artery calcium
  • Risk prediction

ASJC Scopus subject areas

  • Medicine(all)

Fingerprint Dive into the research topics of 'Coronary Artery Calcium and the Age-Specific Competing Risk of Cardiovascular Versus Cancer Mortality: The Coronary Artery Calcium Consortium'. Together they form a unique fingerprint.

Cite this