Very High Coronary Artery Calcium (≥1000) and Association With Cardiovascular Disease Events, Non-Cardiovascular...

Area of Science:

• Cardiology
• Preventive Medicine
• Medical Imaging

Background:

• Limited data exist on cardiovascular disease (CVD), non-CVD, and mortality risks for primary prevention individuals with very high coronary artery calcium (CAC) scores (≥1000).
• Comparison with secondary prevention populations is particularly lacking.

Purpose of the Study:

• To assess the unique risks associated with very high CAC (≥1000) in primary prevention individuals.
• To compare these risks with lower CAC categories and secondary prevention populations.

Main Methods:

• Analysis of 6814 individuals from the Multi-Ethnic Study of Atherosclerosis (MESA) cohort, free of known CVD.
• Comparison of CAC ≥1000 group with CAC 0 and CAC 400-999 groups using Cox regression.
• Event rates for CAC ≥1000 were compared with the placebo group from the FOURIER trial.

Main Results:

• CAC ≥1000 was associated with significantly increased risks for all CVD events, coronary heart disease events, and all-cause mortality compared to CAC 0 and CAC 400-999.
• Individuals with CAC ≥1000 also showed increased risk for non-CVD events.
• The 3-point major adverse cardiovascular event rate for CAC ≥1000 was 3.4 per 100 person-years, similar to the overall FOURIER trial population.

Conclusions:

• Very high CAC (≥1000) identifies a unique primary prevention population at substantially higher risk for CVD, non-CVD outcomes, and mortality.
• These risk rates are comparable to stable, treated secondary prevention patients.
• Future guidelines may need to consider a less distinct stratification between primary and secondary prevention for guiding therapy.