Coronary artery calcium scoring in low risk patients with family history of coronary heart disease: Validation of the SCCT guideline approach in the coronary artery calcium consortium |
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| Affiliation: | 1. Department of Medicine, The Johns Hopkins Hospital, Baltimore, MD, USA;2. Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA;3. Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA;4. Department of Radiology and Neuroradiology, Charité, Berlin, Germany;5. Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA;6. Department of Nuclear Cardiology/Cardiac Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA;7. Department of Medicine, St. Luke''s Roosevelt Hospital Center, New York, NY, USA;8. Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN, USA;9. Department of Medicine, Yale School of Medicine, New Haven, CT, USA;10. Center for Outcomes Research & Evaluation, Yale School of Medicine, New Haven, CT, USA;11. Department of Cardiovascular Imaging, Princeton Longevity Center, Princeton, NJ, USA;12. Department of Radiology and Medicine, Weill Cornell Medical College, New York, NY, USA;13. Aetna Foundation, Hartford, CT, USA;1. East and North Hertfordshire NHS Trust, The Lister Hospital, Stevenage, United Kingdom;2. NIHR Nottingham Biomedical Research Centre, Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, NG72UH, United Kingdom;3. Radiology Department, Royal Papworth Hospital NHS Foundation Trust, Cambridge, CB23 3RE, United Kingdom;1. Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University, Baltimore, MD, USA;2. Department of Radiology and Neuroradiology, Charité, Berlin, Germany;3. Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA;4. Division Cardiovascular Prevention and Wellness, Houston Methodist Hospital, Houston, TX, USA;5. Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA;6. Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA;7. Division of Cardiology, Mount Sinai St. Luke’s Hospital, New York, NY, USA;8. Princeton Longevity Center, Princeton, NJ, USA;9. Department of Medicine, Harbor-UCLA Medical Center, University of California Los Angeles, Los Angeles, CA, USA;10. Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA |
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| Abstract: | BackgroundThe Society of Cardiovascular Computed Tomography (SCCT) recommends consideration of coronary artery calcium (CAC) scoring among individuals with a family history (FH) of coronary heart disease (CHD) and atherosclerotic cardiovascular disease (ASCVD) risk <5%. No dedicated study has examined the prognostic significance of CAC scoring among this population.MethodsThe CAC Consortium is a multi-center observational cohort study from four clinical centers linked to long-term follow-up for cause-specific mortality. All CAC scans were physician referred and performed in patients without a history of CHD. Our analysis includes 14,169 patients with ASCVD scores <5% and self-reported FH of CHD.ResultsThis cohort had a mean age of 48.1 (SD 7.4), was 91.3% white, 47.4% female, had an average ASCVD score of 2.3% (SD 1.3), and 59.4% had a CAC = 0. The event rate for all-cause mortality was 1.2 per 1000 person-years, 0.3 per 1000 person-years for CVD-specific mortality, and 0.2 per 1000 person-years for CHD-specific mortality. In multivariable Cox proportional hazard models, those with CAC>100 had a 2.2 (95% CI 1.5–3.3) higher risk of all-cause mortality, 4.3 (95% CI 1.9–9.5) times higher risk of CVD-specific mortality, and a 10.4 (95% CI 3.2–33.7) times higher risk of CHD-specific mortality compared to individuals with CAC = 0. The NNS to detect CAC >100 in this sample was 9.ConclusionIn otherwise low risk patients with FH of CHD, CAC>100 were associated with increased risk of all-cause and CHD mortality with event rates in a range that may benefit with preventive pharmacotherapy. These data strongly support new SCCT recommendations regarding testing of patients with a family history of CHD. |
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