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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Association between coronary artery calcium and all-cause mortality: A large single-center retrospective cohort study
Mu-Cyun Wang1,2,3, Che-Chen Lin4, Hsiu-Yin Chiang4
1Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan.
Insights
High coronary artery calcium (CAC) scores significantly increase all-cause mortality risk in Asian adults. This risk is particularly pronounced in individuals younger than 65 with very high CAC scores.
Area of Science:
- Cardiology
- Preventive Medicine
- Radiology
Background:
- Coronary artery calcium (CAC) is a known predictor of cardiovascular disease and mortality.
- Existing research is predominantly from Western populations and often excludes individuals with pre-existing heart conditions.
Purpose of the Study:
- To investigate the association between CAC and all-cause mortality in an Asian cohort.
- To analyze this association across various demographic and clinical subgroups.
Main Methods:
- A retrospective cohort study of 4529 participants who underwent multidetector computed tomography.
- Follow-up averaged 3.5 years, with Cox regression used to determine mortality hazards.
- Stratified analyses were performed based on age, sex, smoking, obesity, diabetes, cardiovascular disease, blood pressure, and biochemical parameters.
Main Results:
- All-cause mortality rates increased with higher CAC scores (2.94, 4.88, 17.6, and 33.1 per 1000 person-years for CAC 0, 1-100, 101-400, and >400, respectively).
- Multivariable adjusted hazard ratios for all-cause mortality were 0.95, 1.87, and 3.05 for CAC scores of 1-100, 101-400, and >400, respectively, compared to CAC 0.
- The relative risk of death for CAC > 400 was significantly higher in individuals younger than 65 years (HR 6.46) compared to older adults (HR 1.94), indicating age as a moderator (p=0.02).
Conclusions:
- Elevated CAC scores are strongly associated with increased all-cause mortality in this Asian cohort.
- While older adults face higher absolute mortality risks, younger individuals (<65 years) with very high CAC scores (>400) experience a disproportionately greater relative risk of death.
Objective:
Previous studies have revealed that coronary artery calcium is related to cardiovascular diseases and mortality. However, most studies have been conducted in Western countries and have excluded patients with pre-existing heart disease. We investigated the association between coronary artery calcium (CAC) and all-cause mortality in an Asian cohort and in subgroups stratified by age, sex, smoking, obesity, diabetes, cardiovascular disease, blood pressure, and biochemical parameters.
Methods:
We conducted a retrospective cohort study on 4529 health examinees who underwent multidetector computed tomography in a tertiary medical center in Taiwan between 2011 and 2016. The mean follow-up was 3.5 years. Cox regression was used to estimate the relative hazards of death. Stratified analyses were performed.
Results:
The all-cause mortality rates were 2.94, 4.88, 17.6, and 33.1 per 1000 person-years for CAC scores of 0, 1-100, 101-400, and >400, respectively. The multivariable adjusted hazard ratios (95% confidence intervals [CIs]) for all-cause mortality were 0.95 (0.53, 1.72), 1.87 (0.89, 3.90), and 3.05 (1.46, 6.39) for CAC scores of 1-100, 101-400, and >400, respectively, relative to a CAC score of 0. Compared with CAC ≤ 400, the HRs (95% CIs) for CAC > 400 were 6.46 (2.44, 17.15) and 1.94 (1.00, 3.76) in younger and older adults, respectively, indicating that age was a moderating variable (p = 0.02).
Conclusion:
High CAC scores were associated with increased all-cause mortality. Although older adult patients had higher risks of death, the relative risk of death for patients with CAC > 400 was more prominent in people younger than 65 years.
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