Association of Cardiovascular Health and Time Lived With Zero Coronary Artery Calcium

Zero coronary artery calcium (CAC) is robustly associated with lower risk of cardiovascular disease (CVD). Factors associated with greater time lived with zero CAC are not well understood.

This study aims to evaluate the association of cardiovascular health (CVH) and time lived with zero CAC.

In MESA (Multi-Ethnic Study of Atherosclerosis), participants who had zero CAC at baseline and were followed up to 10 years, restricted mean survival time since study entry lived with zero CAC was estimated by baseline CVH (high, intermediate, low), stratified by sex and age (45-64 years and 65-84 years).

Among 3,416 participants with zero CAC at baseline (63% female, age 58 ± 9 years at baseline, CVH score 8.8 ± 2.1), the years since study entry lived with zero CAC was 4.9 ± 3.5 years. Women with high vs low CVH lived on average 6.6 years (95% CI: 6.4-6.8 years) vs 5.6 years (95% CI: 5.3-5.8 years) with zero CAC (P < 0.01). Men with high vs low CVH lived 6.4 years (95% CI: 5.9-6.9 years) vs 5.5 years (95% CI: 5.1-5.9 years) with zero CAC (P = 0.01). Participants aged 45 to 64 years with high vs low CVH lived 7.4 years (95% CI: 7.1-7.6 years) vs 5.9 years (95% CI: 5.7-6.2 years) with zero CAC (P < 0.01). Participants aged 65 to 84 years at baseline with high vs low CVH lived a similar duration with zero CAC (5.1 years [95% CI: 4.5-5.7 years] vs 4.9 years [95% CI: 4.6-5.2 years]) with zero CAC (P = 0.65).

High CVH was associated with longer time lived with zero CAC. Maintaining high CVH early in midlife may reduce risk of CVD as measured by CAC onset.