TY - JOUR
T1 - Interplay of Coronary Artery Calcium and Risk Factors for Predicting CVD/CHD Mortality
T2 - The CAC Consortium
AU - Grandhi, Gowtham R.
AU - Mirbolouk, Mohammadhassan
AU - Dardari, Zeina A.
AU - Al-Mallah, Mouaz H.
AU - Rumberger, John A.
AU - Shaw, Leslee J.
AU - Blankstein, Ron
AU - Miedema, Michael D.
AU - Berman, Daniel S.
AU - Budoff, Matthew J.
AU - Krumholz, Harlan M.
AU - Blaha, Michael J.
AU - Nasir, Khurram
PY - 2020/5
Y1 - 2020/5
N2 - Objectives: This study sought to evaluate the association and burden of coronary artery calcium (CAC) with long-term, cause-specific mortality across the spectrum of baseline risk. Background: Although CAC is a known predictor of short-term, all-cause mortality, data on long-term and cause-specific mortality are inadequate. Methods: The CAC Consortium cohort is a multicenter cohort of 66,636 participants without coronary heart disease (CHD) who underwent CAC testing. The following risk factors (RFs) were considered: 1) current cigarette smoking; 2) dyslipidemia; 3) diabetes mellitus; 4) hypertension; and 5) family history of CHD. Results: During the 12.5-years median follow-up, 3,158 (4.7%) deaths occurred; 32% were cardiovascular disease (CVD) deaths. Participants with CAC scores ≥400 had a significantly increased risk for CHD and CVD mortality (hazard ratio [HR]: 5.44; 95% confidence interval [CI]: 3.88 to 7.62; and HR: 4.15; 95% CI: 3.29 to 5.22, respectively) compared with CAC of 0. Participants with ≥3 RFs had a smaller increased risk for CHD and CVD mortality (HR: 2.09; 95% CI: 1.52 to 2.85; and HR: 1.84; 95% CI: 1.46 to 2.31, respectively) compared with those without RFs. Across RF strata, CAC added prognostic information. For example, participants without RFs but with CAC ≥400 had significantly higher all-cause, non-CVD, CVD, and CHD mortality rates compared with participants with ≥3 RFs and CAC of 0. Conclusions: Across the spectrum of RF burden, a higher CAC score was strongly associated with long-term, all-cause mortality and a greater proportion of deaths due to CVD and CHD. Absence of CAC identified people with a low risk over 12 years of follow-up, with most deaths being non-CVD in nature, regardless of RF burden.
AB - Objectives: This study sought to evaluate the association and burden of coronary artery calcium (CAC) with long-term, cause-specific mortality across the spectrum of baseline risk. Background: Although CAC is a known predictor of short-term, all-cause mortality, data on long-term and cause-specific mortality are inadequate. Methods: The CAC Consortium cohort is a multicenter cohort of 66,636 participants without coronary heart disease (CHD) who underwent CAC testing. The following risk factors (RFs) were considered: 1) current cigarette smoking; 2) dyslipidemia; 3) diabetes mellitus; 4) hypertension; and 5) family history of CHD. Results: During the 12.5-years median follow-up, 3,158 (4.7%) deaths occurred; 32% were cardiovascular disease (CVD) deaths. Participants with CAC scores ≥400 had a significantly increased risk for CHD and CVD mortality (hazard ratio [HR]: 5.44; 95% confidence interval [CI]: 3.88 to 7.62; and HR: 4.15; 95% CI: 3.29 to 5.22, respectively) compared with CAC of 0. Participants with ≥3 RFs had a smaller increased risk for CHD and CVD mortality (HR: 2.09; 95% CI: 1.52 to 2.85; and HR: 1.84; 95% CI: 1.46 to 2.31, respectively) compared with those without RFs. Across RF strata, CAC added prognostic information. For example, participants without RFs but with CAC ≥400 had significantly higher all-cause, non-CVD, CVD, and CHD mortality rates compared with participants with ≥3 RFs and CAC of 0. Conclusions: Across the spectrum of RF burden, a higher CAC score was strongly associated with long-term, all-cause mortality and a greater proportion of deaths due to CVD and CHD. Absence of CAC identified people with a low risk over 12 years of follow-up, with most deaths being non-CVD in nature, regardless of RF burden.
KW - coronary artery calcium
KW - mortal
KW - risk factors
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UR - http://www.scopus.com/inward/citedby.url?scp=85083578465&partnerID=8YFLogxK
U2 - 10.1016/j.jcmg.2019.08.024
DO - 10.1016/j.jcmg.2019.08.024
M3 - Article
C2 - 31734198
AN - SCOPUS:85083578465
VL - 13
SP - 1175
EP - 1186
JO - JACC: Cardiovascular Imaging
JF - JACC: Cardiovascular Imaging
SN - 1936-878X
IS - 5
ER -