Coronary artery calcium as a predictor of coronary heart disease, cardiovascular disease, and all-cause mortality in Asian-Americans: The Coronary Artery Calcium Consortium

Olusola A. Orimoloye, Sandeep Banga, Zeina A. Dardari, S. M.Iftekhar Uddin, Matthew J. Budoff, Daniel S. Berman, Alan Rozanski, Leslee J. Shaw, John A. Rumberger, Khurram Nasir, Michael D. Miedema, Roger S. Blumenthal, Michael J. Blaha, Mohammadhassan Mirbolouk

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

Background Coronary artery calcium (CAC) has been shown in multiple populations to predict atherosclerotic cardiovascular disease. However, its predictive value in Asian-Americans is poorly described. Patients and methods We studied 1621 asymptomatic Asian-Americans in the CAC Consortium, a large multicenter retrospective cohort. CAC was modeled in categorical (CAC = 0; CAC = 1-99; CAC = 100-399; CAC ≥ 400) and continuous [ln (CAC + 1)] forms. Participants were followed over a mean follow-up of 12 ± 4 years for coronary heart disease (CHD) death, cardiovascular disease (CVD) death, and all-cause mortality. The predictive value of CAC for individual outcomes was assessed using multivariable-adjusted Cox regression models adjusted for traditional cardiovascular risk factors and reported as hazard ratios (95% confidence interval). Results The mean (SD) age of the population was 54 (11.2) years and 64% were men. The mean 10-year atherosclerotic cardiovascular disease risk score was 8%. Approximately half had a CAC score of 0, whereas 22.5% had a CAC score of greater than 100. A total of 56 deaths (16 CVD and 8 CHD) were recorded, with no CVD or CHD deaths in the CAC = 0 group. We noted a significantly increased risk of CHD [hazard ratio (HR): 2.6 (1.5-4.3)] and CVD [HR: 2.3 (1.8-2.9)] mortality per unit increase in In (CAC + 1). Compared to those with CAC scores of 0, individuals with CAC scores of at least 400 had over a three-fold increased risk of all-cause mortality [HR: 3.3 (1.3-8.6)]. Conclusion Although Asian-Americans are a relatively low-risk group, CAC strongly predicts CHD, CVD, and all-cause mortality beyond traditional risk factors. These findings may help address existing knowledge gaps in CVD risk prediction in Asian-Americans.

Original languageEnglish (US)
Pages (from-to)608-614
Number of pages7
JournalCoronary Artery Disease
Volume30
Issue number8
DOIs
StatePublished - Dec 1 2019

Keywords

  • Asian-Americans
  • coronary artery calcium score
  • race/ethnicity
  • risk prediction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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