Coronary artery calcium as a synergistic tool for the age-and sex-specific risk of cardiovascular and cancer mortality: The coronary artery calcium consortium

BACKGROUND: Coronary artery calcium (CAC) is a predictor for the development of cardiovascular disease (CVD) and to a lesser extent cancer. The age-and sex-specific relationship of CAC with CVD and cancer mortality is unknown. METHODS AND RESULTS: Asymptomatic patients aged 40 to 75 years old without known CVD were included from the CAC Consortium. We calculated sex-specific mortality rates per 1000 person-years’ follow-up. Using parametric survival regression modeling, we determined the age-and sex-specific CAC score at which the risk of death from CVD and cancer were equal. Among the 59 502 patients included in this analysis, the mean age was 54.9 (±8.5) years, 34% were women, and 89% were white. There were 671 deaths attributable to CVD and 954 deaths attributable to cancer over a mean follow-up of 12±3 years. Among patients with CAC=0, cancer was the leading cause of death, the total mortality rate was low (women, 1.8; men, 1.5), and the CVD mortality rate was exceedingly low for women (0.3) and men (0.3). The age-specific CAC score at which the risk of CVD and cancer mortality were equal had a U-shaped relationship for women, while the relationship was exponential for men. CONCLUSIONS: The age-and sex-specific relationship of CAC with CVD and cancer mortality differed significantly for women and men. Our age-and sex-specific CAC score provides a more precise estimate and further facilitates the use of CAC as a synergistic tool in strategies for the prediction and prevention of CVD and cancer mortality.