Interplay of Coronary Artery Calcium and Risk Factors for Predicting CVD/CHD Mortality: The CAC Consortium

Gowtham R. Grandhi, Mohammadhassan Mirbolouk, Zeina A. Dardari, Mouaz H. Al-Mallah, John A. Rumberger, Leslee J. Shaw, Ron Blankstein, Michael D. Miedema, Daniel S. Berman, Matthew J. Budoff, Harlan M. Krumholz, Michael J. Blaha, Khurram Nasir

Research output: Contribution to journalArticlepeer-review

54 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)1175-1186
Number of pages12
JournalJACC: Cardiovascular Imaging
Issue number5
StatePublished - May 2020


  • coronary artery calcium
  • mortal
  • risk factors
  • Predictive Value of Tests
  • Prevalence
  • Prognosis
  • Humans
  • Middle Aged
  • Male
  • Smoking/adverse effects
  • Cause of Death
  • United States/epidemiology
  • Vascular Calcification/diagnostic imaging
  • Diabetes Mellitus/mortality
  • Dyslipidemias/mortality
  • Time Factors
  • Hypertension/mortality
  • Adult
  • Female
  • Retrospective Studies
  • Multidetector Computed Tomography
  • Risk Assessment
  • Computed Tomography Angiography
  • Coronary Artery Disease/diagnostic imaging
  • Coronary Angiography
  • Aged
  • Heart Disease Risk Factors

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging


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