Coronary Artery Calcium for Risk Stratification of Heart Failure Mortality: The Coronary Artery Calcium Consortium

There is increasing interest in predicting heart failure (HF), a major cause of morbidity and mortality with a significant financial burden. The role of coronary artery calcium (CAC), an accessible and inexpensive test, in predicting long-term HF mortality among asymptomatic adults remains unknown. We aimed to determine whether CAC burden is associated with HF-related mortality in the CAC Consortium.

The study included 66,636 primary prevention patients from the CAC Consortium. Multivariable competing risks regression was used to assess the association between CAC and HF-related mortality adjusting for demographics and traditional risk factors. The mean age was 54.4 years, 67% male, 89% White, and 55% had a CAC of >0. We observed 260 HF-related mortality events during a median follow up of 12.5 years; 75.3% occurred among those with a baseline CAC score of >100. Compared with a CAC of 0, there was a stepwise higher risk (P < .005) of HF mortality for a CAC of 1-100 (subdistribution hazard ratio [SHR] 2.27, 95% CI 1.3-3.99), 100-400 (SHR 3.68, 95% CI 2.1-6.43), and >400 (SHR 7.05, 95% CI 4.05-12.29). This increasing risk of HF mortality across higher CAC scores persisted across age groups, sex, and in the intermediate and high-risk groups as calculated by the pooled cohort equation and Predicting Risk of cardiovascular disease EVENTs (PREVENT) equation.

A higher CAC is associated with an increasing incidence of long-term HF-related mortality in the primary prevention population, particularly intermediate and high-risk patients. Early preventive approaches in patients with high CAC must focus on preventing HF and atherosclerotic cardiovascular disease with lifestyle changes and medications.