Author + information
- Received March 14, 2019
- Revision received July 25, 2019
- Accepted August 23, 2019
- Published online May 4, 2020.
- Gowtham R. Grandhi, MD, MPHa,
- Mohammadhassan Mirbolouk, MDb,
- Zeina A. Dardari, MSb,
- Mouaz H. Al-Mallah, MD, MScc,
- John A. Rumberger, MD, PhDd,
- Leslee J. Shaw, PhDe,
- Ron Blankstein, MDf,
- Michael D. Miedema, MD, MPHg,
- Daniel S. Berman, MDh,
- Matthew J. Budoff, MDi,
- Harlan M. Krumholz, MD, SMa,j,k,
- Michael J. Blaha, MD, MPHb and
- Khurram Nasir, MD, MPH, MScl,∗ ()
- aCenter for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- bThe Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Maryland
- cHouston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
- dPrinceton Longevity Center, Princeton, New Jersey
- eWeill Cornell Medical College, New York, New York
- fCardiovascular Division and Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts
- gMinneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
- hDepartment of Imaging, Cedars-Sinai Medical Center, Los Angeles, California
- iDepartment of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California
- jSection of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
- kDepartment of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
- lDivision of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart & Vascular Center, and Center for Outcomes Research (COR) Houston Methodist, Houston, Texas
- ↵∗Address for correspondence:
Dr. Khurram Nasir, Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart & Vascular Center & Center for Outcomes Research Houston Methodist, 6550 Fannin Street, Suite 1801, Houston, Texas 77030.
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.
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.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Imaging author instructions page.
- Received March 14, 2019.
- Revision received July 25, 2019.
- Accepted August 23, 2019.
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