Interplay of Coronary Artery Calcium and Risk Factors for Predicting CVD/CHD Mortality: The CAC Consortium |
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Affiliation: | 1. Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut;2. The Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Maryland;3. Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas;4. Princeton Longevity Center, Princeton, New Jersey;5. Weill Cornell Medical College, New York, New York;6. Cardiovascular Division and Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts;7. Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota;8. Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California;9. Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California;10. Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut;11. Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut;12. Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart & Vascular Center, and Center for Outcomes Research (COR) Houston Methodist, Houston, Texas |
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Abstract: | ObjectivesThis 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.BackgroundAlthough CAC is a known predictor of short-term, all-cause mortality, data on long-term and cause-specific mortality are inadequate.MethodsThe 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.ResultsDuring 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.ConclusionsAcross 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. |
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Keywords: | coronary artery calcium mortal risk factors ASCVD" },{" #name" :" keyword" ," $" :{" id" :" kwrd0030" }," $$" :[{" #name" :" text" ," _" :" atherosclerotic cardiovascular disease CAC" },{" #name" :" keyword" ," $" :{" id" :" kwrd0040" }," $$" :[{" #name" :" text" ," _" :" coronary artery calcium CHD" },{" #name" :" keyword" ," $" :{" id" :" kwrd0050" }," $$" :[{" #name" :" text" ," _" :" coronary heart disease CI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0060" }," $$" :[{" #name" :" text" ," _" :" confidence interval CVD" },{" #name" :" keyword" ," $" :{" id" :" kwrd0070" }," $$" :[{" #name" :" text" ," _" :" cardiovascular disease HDL-C" },{" #name" :" keyword" ," $" :{" id" :" kwrd0080" }," $$" :[{" #name" :" text" ," _" :" high-density lipoprotein cholesterol HR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0090" }," $$" :[{" #name" :" text" ," _" :" hazard ratio LDL-C" },{" #name" :" keyword" ," $" :{" id" :" kwrd0100" }," $$" :[{" #name" :" text" ," _" :" low-density lipoprotein cholesterol RF" },{" #name" :" keyword" ," $" :{" id" :" kwrd0110" }," $$" :[{" #name" :" text" ," _" :" risk factor |
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