Long-Term All-Cause and Cause-Specific Mortality in Asymptomatic Patients With CAC ≥1,000: Results From the CAC Consortium

Allison W. Peng, Mohammadhassan Mirbolouk, Olusola A. Orimoloye, Albert D. Osei, Zeina Dardari, Omar Dzaye, Matthew J. Budoff, Leslee Shaw, Michael D. Miedema, John Rumberger, Daniel S. Berman, Alan Rozanski, Mouaz H. Al-Mallah, Khurram Nasir, Michael J. Blaha

Research output: Contribution to journalArticlepeer-review

80 Scopus citations


Objectives: This study thoroughly explored the demographic and imaging characteristics, as well as the all-cause and cause-specific mortality risks of patients with a coronary artery calcium (CAC) score ≥1,000 in the largest dataset of this population to date. Background: CAC is commonly used to quantify cardiovascular risk. Current guidelines classify a CAC score of >300 or 400 as the highest risk group, yet little is known about the potentially unique imaging characteristics and mortality risk in individuals with a CAC score ≥1,000. Methods: A total of 66,636 asymptomatic adults were included from the CAC consortium, a large retrospective multicenter clinical cohort. Mean patient follow-up was 12.3 ± 3.9 years for patients with cardiovascular disease (CVD), coronary heart disease (CHD), cancer, and all-cause mortality. Multivariate Cox proportional hazards regression models adjusted for age, sex, and conventional risk factors were used to assess the relative mortality hazard of individuals with CAC ≥1,000 compared with, first, a CAC reference of 0, and second, with patients with a CAC score of 400 to 999. Results: There were 2,869 patients with CAC ≥1,000 (86.3% male, mean 66.3 ± 9.7 years of age). Most patients with CAC ≥1,000 had 4-vessel CAC (mean: 3.5 ± 0.6 vessels) and had greater total CAC area, higher mean CAC density, and more extracoronary calcium (79% with thoracic artery calcium, 46% with aortic valve calcium, and 21% with mitral valve calcium) than those with CAC scores of 400 to 999. After full adjustment, those with CAC ≥1,000 had a 5.04- (95% confidence interval [CI]: 3.92 to 6.48), 6.79- (95% CI: 4.74 to 9.73), 1.55- (95% CI:1.23 to 1.95), and 2.89-fold (95% CI: 2.53 to 3.31) risk of CVD, CHD, cancer, and all-cause mortality, respectively, compared to those with CAC score of 0. The CAC ≥1,000 group had a 1.71- (95% CI: 1.41 to 2.08), 1.84- (95% CI: 1.43 to 2.36), 1.36- (95% CI:1.07 to 1.73), and 1.51-fold (95% CI: 1.33 to 1.70) increased risk of CVD, CHD, cancer, and all-cause mortality compared to those with CAC scores 400 to 999. Graphic analysis of CAC ≥1,000 patients revealed continued logarithmic increase in risk, with no clear evidence of a risk plateau. Conclusions: Patients with extensive CAC (CAC ≥1,000) represent a unique very high-risk phenotype with mortality outcomes commensurate with high-risk secondary prevention patients. Future guidelines should consider CAC ≥1,000 patients to be a distinct risk group who may benefit from the most aggressive preventive therapy.

Original languageEnglish (US)
Pages (from-to)83-93
Number of pages11
JournalJACC: Cardiovascular Imaging
Issue number1 Pt 1
StatePublished - Jan 2020


  • cardiovascular imaging
  • coronary artery calcium
  • high risk
  • primary prevention
  • risk scoring
  • Severity of Illness Index
  • Prognosis
  • Risk Assessment
  • United States
  • Humans
  • Middle Aged
  • Risk Factors
  • Male
  • Asymptomatic Diseases
  • Cause of Death
  • Computed Tomography Angiography
  • Coronary Artery Disease/diagnostic imaging
  • Coronary Angiography
  • Vascular Calcification/diagnostic imaging
  • Time Factors
  • Aged, 80 and over
  • Female
  • Aged
  • Retrospective Studies

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging


Dive into the research topics of 'Long-Term All-Cause and Cause-Specific Mortality in Asymptomatic Patients With CAC ≥1,000: Results From the CAC Consortium'. Together they form a unique fingerprint.

Cite this