Coronary Artery Calcium Dispersion and Cause-Specific Mortality

Ramzi Dudum, Zeina A. Dardari, David I. Feldman, Daniel S. Berman, Matthew J. Budoff, Michael D. Miedema, Khurram Nasir, Alan Rozanski, John A. Rumberger, Leslee Shaw, Omar Dzaye, Miguel Caínzos-Achirica, Jaideep Patel, Michael J. Blaha

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Coronary artery calcium (CAC) measures subclinical atherosclerosis and improves risk stratification. CAC characteristics—including vessel(s) involved, number of vessels, volume, and density—have been shown to differentially impact risk. We assessed how dispersion—either the number of calcified vessels or CAC phenotype (diffuse, normal, and concentrated)—impacted cause-specific mortality. The CAC Consortium is a retrospective cohort of 66,636 participants without coronary heart disease (CHD) who underwent CAC scoring. This study included patients with CAC >0 (n = 28,147). CAC area, CAC density, and CAC phenotypes (derived from the index of diffusion = 1 – [CAC in most concentrated vessel/total Agatston score]) were calculated. The associations between CAC characteristics and cause-specific mortality were assessed. The participant details included (n = 28,147): mean age 58.3 years, 25% female, 89.6% White, and 66% had 2+ calcified vessels. Diabetes, hypertension, and hyperlipidemia were predictors of multivessel involvement (p <0.001). After controlling for the overall CAC score, those with 4-vessel CAC involvement had more CAC area and less dense calcifications than those with 1-vessel. There was a graded increase in all-cause and cardiovascular disease (CVD)- and CHD-specific mortality as the number of calcified vessels increased. Among those with ≥2 vessels involved (n = 18,516), a diffuse phenotype was associated with a higher CVD-specific mortality and had a trend toward higher all-cause and CHD-specific mortality than a concentrated CAC phenotype. Diffuse CAC involvement was characterized by less dense calcification, more CAC area, multiple coronary vessel involvement, and presence of certain traditional risk factors. There is a graded increase in all-cause and CVD- and CHD-specific mortality with increasing CAC dispersion.

Original languageEnglish (US)
Pages (from-to)76-83
Number of pages8
JournalAmerican Journal of Cardiology
StatePublished - Mar 15 2023


  • Humans
  • Female
  • Male
  • Coronary Artery Disease
  • Calcium
  • Coronary Angiography
  • Coronary Vessels/diagnostic imaging
  • Risk Assessment
  • Cause of Death
  • Retrospective Studies
  • Vascular Calcification/diagnostic imaging
  • Risk Factors
  • Cardiovascular Diseases

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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