Abstract 20360: Modeling Coronary Artery Calcium and the Competing Long-Term Risk of Cardiovascular Versus Non-cardiovascular Mortality: The Cac Consortium
Background: Coronary artery calcium (CAC) is one of the strongest predictors of cardiovascular disease (CVD), but it is also associated with chronic non-CVD such as cancer. There is limited data on the relative associations between CAC and CVD versus non-CVD mortality.
Methods: Four participating institutions contributed 66,636 individuals with CAC scans results and risk factor data to the CAC Consortium. All CAC scans were performed for clinical CVD risk assessment in patients without known coronary heart disease (CHD). CAC was categorized as 0, 1-99, 100-399, and ≥400. Mortality was assessed through linkage to the Social Security Death Index and death certificates were subsequently obtained from the National Death Index. The risk of cause-specific mortality was calculated using Cox models and competing risks models were calculated using the Fine and Gray method.
Results: The mean age was 54 ± 11 years, 67% of patients were male, 45% of patients had CAC=0, and half had a 10-year ASCVD risk of <5%. There were 3,158 deaths (3.9 per 1,000 person-years) identified over a mean follow-up of 12 ± 4 years; 37% of deaths were due to cancer and 32% were due to CVD. Cancer was the leading cause of death among patients with CAC=0 (42%), while CVD was the leading cause of death among patients with CAC ≥400 (41%). Compared to those with CAC=0 the hazard of CVD mortality compared to non-CVD mortality was 1.46 (95% CI 1.16-1.85), 2.39 (95% CI 1.88-3.04), and 4.08 (95% CI 3.20-5.20) for patients with CAC 1-99, 100-399, and ≥400, respectively. CVD surpasses cancer as the leading cause of death at a CAC score of approximately 300 (figure).
Discussion: Cancer was the leading cause of death for patients with CAC=0. Among patients with CAC there is a consistent and significant association between CAC and CVD mortality even after taking into account competing risks.
Author Disclosures: S. Whelton: None. K. Nasir: None. R. Blumenthal: None. Z. Dardari: None. M. iedema: None. J. Rumberger: None. L. Shaw: None. D. Berman: None. M. Budoff: None. M. Blaha: None.
- © 2016 by American Heart Association, Inc.