Coronary artery calcium is associated with increased risk for lung and colorectal cancer in men and women: the Multi-Ethnic Study of Atherosclerosis (MESA)

Omar Dzaye, Philipp Berning, Zeina A. Dardari, Martin Bødtker Mortensen, Catherine Handy Marshall, Khurram Nasir, Matthew J. Budoff, Roger S. Blumenthal, Seamus P. Whelton, Michael J. Blaha

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Aims: This study explored the association of coronary artery calcium (CAC) with incident cancer subtypes in the Multi-Ethnic Study of Atherosclerosis (MESA). CAC is an established predictor of cardiovascular disease (CVD), with emerging data also supporting independent predictive value for cancer. The association of CAC with risk for individual cancer subtypes is unknown. Methods and results: We included 6271 MESA participants, aged 45-84 and without known CVD or self-reported history of cancer. There were 777 incident cancer cases during mean follow-up of 12.9 ± 3.1 years. Lung and colorectal cancer (186 cases) were grouped based on their strong overlap with CVD risk profile; prostate (men) and ovarian, uterine, and breast cancer (women) were considered as sex-specific cancers (in total 250 cases). Incidence rates and Fine and Gray competing risks models were used to assess relative risk of cancer-specific outcomes stratified by CAC groups or Log(CAC+1). The mean age was 61.7 ± 10.2 years, 52.7% were women, and 36.5% were White. Overall, all-cause cancer incidence increased with CAC scores, with rates per 1000 person-years of 13.1 [95% confidence interval (CI): 11.7-14.7] for CAC = 0 and 35.8 (95% CI: 30.2-42.4) for CAC ≥400. Compared with CAC = 0, hazards for those with CAC ≥400 were increased for lung and colorectal cancer in men [subdistribution hazard ratio (SHR): 2.2 (95% CI: 1.1-4.7)] and women [SHR: 2.2 (95% CI: 1.0-4.6)], but not significantly for sex-specific cancers across sexes. Conclusion: CAC scores were associated with cancer risk in both sexes; however, this was stronger for lung and colorectal when compared with sex-specific cancers. Our data support potential synergistic use of CAC scores in the identification of both CVD and lung and colorectal cancer risk.

Original languageEnglish (US)
Pages (from-to)708-716
Number of pages9
JournalEuropean Heart Journal Cardiovascular Imaging
Issue number5
StatePublished - May 1 2022


  • cancer
  • cardiovascular disease
  • coronary arterial calcium
  • prevention
  • risk prediction
  • Prospective Studies
  • Calcium
  • Risk Assessment
  • Vascular Calcification/complications
  • Cardiovascular Diseases/epidemiology
  • Colorectal Neoplasms/complications
  • Humans
  • Lung
  • Middle Aged
  • Risk Factors
  • Male
  • Coronary Artery Disease/complications
  • Coronary Vessels
  • Atherosclerosis/epidemiology
  • Female
  • Aged

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging


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