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
N1 - Funding Information:
Dr. Budoff has received grant support from GE. Dr. Krumholz has been the Chair of the Cardiac Scientific Advisory Board for UnitedHealth; is the owner of Hugo; has been a participant representative on the Life Sciences Board for IBM Watson Health; has been a member of the advisory board for Element Health; has been a member of the Physician Advisory Board for Aetna; has received contracts from the Centers for Medicare and Medicaid; has received research grants from Medtronic, Johnson & Johnson, and the Food and Drug Administration; has been a member of the advisory board for Facebook; has a research agreement with the Shenzhen Center for Health Information; and has research collaboration with the National Center for Cardiovascular Diseases, Beijing. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Harvey Hecht, MD, served as Guest Editor for this paper.
Publisher Copyright:
© 2020
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
UR - http://www.scopus.com/inward/record.url?scp=85083578465&partnerID=8YFLogxK
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 -