Highlights
- •We evaluated 66,363 individuals from the Coronary Artery Calcium (CAC) Consortium.
- •CAC = 0 participants had stable low 12-year rates of cardiovascular death.
- •Cancer was the predominant cause of the infrequent deaths in the CAC = 0 group.
- •CAC 1–10 was associated with higher risk of cardiovascular death at ages <40.
- •CAC>10 was associated with higher risk of cardiovascular and all-cause death.
Abstract
Background and aims
The long-term associations between zero, minimal coronary artery calcium (CAC) and
cause-specific mortality are currently unknown, particularly after accounting for
competing risks with other causes of death.
Methods
We evaluated 66,363 individuals from the CAC Consortium (mean age 54 years, 33% women),
a multi-center, retrospective cohort study of asymptomatic individuals undergoing
CAC scoring for clinical risk assessment. Baseline evaluations occurred between 1991
and 2010.
Results
Over a mean of 12 years of follow-up, individuals with CAC = 0 (45% prevalence, mean
age 45 years) had stable low rates of coronary heart disease (CHD) death, cardiovascular
disease (CVD) death (ranging 0.32 to 0.43 per 1000 person-years), and all-cause death
(1.38–1.62 per 1000 person-years). Cancer was the predominant cause of death in this
group, yet rates were also very low (0.47–0.79 per 1000 person-years). Compared to
CAC = 0, individuals with CAC 1–10 had an increased multivariable-adjusted risk of
CVD death only under age 40. Individuals with CAC>10 had multivariable-adjusted increased
risks of CHD death, CVD death and all-cause death at all ages, and a higher proportion
of CVD deaths.
Conclusions
CAC = 0 is a frequent finding among individuals undergoing CAC scanning for risk assessment
and is associated with low rates of all-cause death at 12 years of follow-up. Our
results support the emerging consensus that CAC = 0 represents a unique population
with favorable all-cause prognosis who may be considered for more flexible treatment
goals in primary prevention. Detection of any CAC in young adults could be used to
trigger aggressive preventive interventions.
Graphical abstract
Graphical Abstract
Keywords
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Article Info
Publication History
Published online: November 16, 2019
Accepted:
November 12,
2019
Received in revised form:
November 5,
2019
Received:
October 20,
2019
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
