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Published on: August 28, 2018
Interplay of Coronary Artery Calcium and Risk Factors for Predicting CVD/CHD Mortality: The CAC Consortium
Gowtham R Grandhi1, Mohammadhassan Mirbolouk2, Zeina A Dardari2
1Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut.
Insights
High coronary artery calcium (CAC) scores significantly increase long-term mortality risk, especially from cardiovascular disease (CVD). An absence of CAC indicates low risk over 12 years, regardless of other risk factors.
Area of Science:
- Cardiology
- Preventive Medicine
- Epidemiology
Background:
- Coronary artery calcium (CAC) is a known predictor of short-term, all-cause mortality.
- Data on the association of CAC with long-term and cause-specific mortality are limited.
Purpose of the Study:
- To evaluate the association and burden of CAC with long-term, cause-specific mortality.
- To assess the prognostic value of CAC across different levels of traditional cardiovascular risk factors.
Main Methods:
- Utilized the CAC Consortium cohort, a multicenter study of 66,636 participants without coronary heart disease (CHD).
- Assessed traditional risk factors: smoking, dyslipidemia, diabetes, hypertension, and family history of CHD.
- Analyzed mortality outcomes over a median follow-up of 12.5 years.
Main Results:
- A CAC score ≥400 was associated with significantly increased risk for CHD and CVD mortality compared to CAC of 0.
- Having ≥3 traditional risk factors also increased CHD and CVD mortality risk, but to a lesser extent than high CAC.
- CAC provided additional prognostic information across all strata of traditional risk factors.
Conclusions:
- Higher CAC scores are strongly linked to long-term all-cause mortality and a greater proportion of CVD and CHD deaths.
- Absence of CAC identifies individuals at low long-term risk, with most deaths being non-CVD related, irrespective of traditional risk factor burden.
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.
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