Author + information
- Received October 26, 2018
- Revision received January 18, 2019
- Accepted February 27, 2019
- Published online March 15, 2019.
- Allison W. Peng, BSa,
- Mohammadhassan Mirbolouk, MDa,
- Olusola A. Orimoloye, MBBS, MPHa,
- Albert D. Osei, MD, MPHa,
- Zeina Dardari, MSa,
- Omar Dzaye, MD, PhDa,
- Matthew J. Budoff, MDb,
- Leslee Shaw, PhDc,
- Michael D. Miedema, MD, MPHd,
- John Rumberger, MD, PhDe,
- Daniel S. Berman, MDf,
- Alan Rozanski, MDg,
- Mouaz H. Al-Mallah, MDh,
- Khurram Nasir, MD, MPHi and
- Michael J. Blaha, MD, MPHa,∗ ()
- aJohns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, MD, US
- bDepartment of Medicine, Harbor-UCLA Medical Center, Los Angeles, CA, US
- cDivision of Cardiology, Emory University School of Medicine, Atlanta, GA, US
- dMinneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, US
- ePrinceton Longevity Center, Princeton, NJ, US
- fDepartment of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, US
- gDivision of Cardiology, Mount Sinai St. Luke’s Hospital, New York, NY, US
- hCardiovascular Imaging Department, Houston Methodist Hospital, Houston, TX, US
- iCenter for Outcomes Research and Evaluation (CORE), Section of Cardiovascular Medicine, Yale University School of Medicine
- ↵∗Corresponding Author: Michael J. Blaha, MD, MPH Director of Clinical Research, Ciccarone Center for the Prevention of Heart Disease Associate Professor of Medicine Blalock 524D1 600 N. Wolfe Street Baltimore, MD 21287 Phone: 410-955-7376 Fax: 410-614-9190.
Objectives We thoroughly explored the demographic and imaging characteristics, as well as all-cause and cause-specific mortality of CAC≥1000 patients in the largest dataset of this population to date.
Background Coronary artery calcium (CAC) is commonly used to quantify cardiovascular risk. Current guidelines classify CAC>300 or 400 as the highest risk group, yet little is known about the potentially unique imaging characteristics and mortality risk in individuals with CAC≥1000.
Methods We included 66,636 asymptomatic adults from the CAC Consortium, a large retrospective multicenter clinical cohort. Mean patient follow-up was 12.3 ± 3.9 years for CVD, CHD, cancer, and all-cause mortality. Using multivariable Cox proportional hazards regression models adjusted for age, sex, and traditional risk factors, we assessed the relative mortality hazard of individuals with CAC≥1000 compared first against a reference of CAC=0, and then against CAC 400-999.
Results There were 2,869 patients with CAC≥1000 (86.3% male, mean age 66.3 ± 9.7 years). Most CAC≥1000 patients had 4-vessel CAC (mean 3.5 ± 0.6 vessels), and had greater total CAC area, higher mean CAC density, and more extra-coronary calcium (79% with TAC, 46% with AVC, 21% with MVC) compared to CAC 400-999. After full adjustment, those with CAC≥1000 had 5.04 (3.92-6.48), 6.79 (4.74-9.73), 1.55 (1.23-1.95), and 2.89-fold (2.53-3.31) risk of CVD, CHD, cancer, and all-cause mortality, respectively, compared to those with CAC=0. The CAC≥1000 group had a 1.71- (1.41-2.08), 1.84- (1.43-2.36), 1.36- (1.07-1.73), and 1.51-fold (1.33-1.70) increased CVD, CHD, cancer, and all-cause mortality compared to CAC 400-999. Graphical analysis of CAC≥1000 revealed continued logarithmic increase in risk, with no clear evidence of a risk plateau.
Conclusions Patients with extensive CAC (CAC≥1000) represent a unique very high-risk phenotype with mortality outcomes commensurate with high-risk secondary prevention patients. Future guidelines should consider CAC≥1000 a distinct risk group which may benefit from the most aggressive preventive therapy.
Disclosures: The authors have no disclosures to support.
Grants and Financial Support: MJB is supported by NIH/NHLBI L30 HL110027. There are no financial disclosures to support.
- Received October 26, 2018.
- Revision received January 18, 2019.
- Accepted February 27, 2019.