OBJECTIVES: We sought to quantify the mortality rates associated with absent and low positive (CAC 1 to 10) coronary artery calcium (CAC). BACKGROUND: There is increasing interest in the absence of CAC as a "negative" cardiovascular risk factor. However, published event rates for individuals with no CAC vary, likely owing to differences in baseline risk, follow-up period, and outcome ascertainment. The prognostic significance of low CAC (CAC 1 to 10) is not well described. METHODS: Annualized all-cause mortality rates were assessed in 44,052 consecutive asymptomatic patients referred for CAC testing. Mean follow-up of the cohort was 5.6 +/- 2.6 years (range 1 to 13 years). RESULTS: A total of 19,898 patients (45%) had no CAC on screening electron beam tomography, whereas 5,388 (12%) had low levels of CAC (CAC 1 to 10), and 18,766 (43%) had CAC >10. There were 104 deaths in those with no CAC (0.52%), 58 deaths in those with CAC 1 to 10 (1.06%), and 739 deaths in those with CAC >10 (3.96%). Annualized all-cause mortality rates for CAC = 0, CAC 1 to 10, and CAC >10 were 0.87, 1.92, and 7.48 deaths/1,000 person-years, respectively. The hazard ratio (HR) for all-cause mortality among CAC 1 to 10 versus CAC = 0 after adjustment for traditional risk factors was 1.99 (95% confidence interval [CI]: 1.44 to 2.75). Smoking (HR: 3.97, 95% CI: 2.75 to 5.41) and diabetes mellitus (HR: 3.36, 95% CI: 2.09 to 5.41) were associated with few events observed in CAC = 0 group. CONCLUSIONS: In appropriately selected asymptomatic patients, the absence of CAC predicts excellent survival with 10-year event rates of approximately 1%. A finding of 0 CAC might be used as a rationale to emphasize lifestyle therapies rather than pharmacotherapy and to forgo repeated imaging studies. Individuals with low CAC score (CAC 1 to 10) are at increased risk above individuals with a 0 score and could be considered a distinct risk group by physicians and investigators.
OBJECTIVES: We sought to quantify the mortality rates associated with absent and low positive (CAC 1 to 10) coronary artery calcium (CAC). BACKGROUND: There is increasing interest in the absence of CAC as a "negative" cardiovascular risk factor. However, published event rates for individuals with no CAC vary, likely owing to differences in baseline risk, follow-up period, and outcome ascertainment. The prognostic significance of low CAC (CAC 1 to 10) is not well described. METHODS: Annualized all-cause mortality rates were assessed in 44,052 consecutive asymptomatic patients referred for CAC testing. Mean follow-up of the cohort was 5.6 +/- 2.6 years (range 1 to 13 years). RESULTS: A total of 19,898 patients (45%) had no CAC on screening electron beam tomography, whereas 5,388 (12%) had low levels of CAC (CAC 1 to 10), and 18,766 (43%) had CAC >10. There were 104 deaths in those with no CAC (0.52%), 58 deaths in those with CAC 1 to 10 (1.06%), and 739 deaths in those with CAC >10 (3.96%). Annualized all-cause mortality rates for CAC = 0, CAC 1 to 10, and CAC >10 were 0.87, 1.92, and 7.48 deaths/1,000 person-years, respectively. The hazard ratio (HR) for all-cause mortality among CAC 1 to 10 versus CAC = 0 after adjustment for traditional risk factors was 1.99 (95% confidence interval [CI]: 1.44 to 2.75). Smoking (HR: 3.97, 95% CI: 2.75 to 5.41) and diabetes mellitus (HR: 3.36, 95% CI: 2.09 to 5.41) were associated with few events observed in CAC = 0 group. CONCLUSIONS: In appropriately selected asymptomatic patients, the absence of CAC predicts excellent survival with 10-year event rates of approximately 1%. A finding of 0 CAC might be used as a rationale to emphasize lifestyle therapies rather than pharmacotherapy and to forgo repeated imaging studies. Individuals with low CAC score (CAC 1 to 10) are at increased risk above individuals with a 0 score and could be considered a distinct risk group by physicians and investigators.
Authors: Sana Shah; Naveen Bellam; Jonathon Leipsic; Daniel S Berman; Arshed Quyyumi; Jörg Hausleiter; Stephan Achenbach; Mouaz Al-Mallah; Matthew J Budoff; Fillippo Cademartiri; Tracy Q Callister; Hyuk-Jae Chang; Benjamin J W Chow; Ricardo C Cury; Augustin J Delago; Allison L Dunning; Gudrun M Feuchtner; Martin Hadamitzky; Ronald P Karlsberg; Philipp A Kaufmann; Fay Y Lin; Kavitha M Chinnaiyan; Erica Maffei; Gilbert L Raff; Todd C Villines; Millie J Gomez; James K Min; Leslee J Shaw Journal: J Nucl Cardiol Date: 2014-03-29 Impact factor: 5.952
Authors: Randy Cohen; Matthew Budoff; Robyn L McClelland; Stefan Sillau; Gregory Burke; Michael Blaha; Moyses Szklo; Seth Uretsky; Alan Rozanski; Steven Shea Journal: Am J Cardiol Date: 2014-07-30 Impact factor: 2.778
Authors: Faisal Rahman; Mahmoud Al Rifai; Michael J Blaha; Khurram Nasir; Matthew J Budoff; Bruce M Psaty; Wendy S Post; Roger S Blumenthal; John W McEvoy Journal: Am J Cardiol Date: 2017-08-08 Impact factor: 2.778
Authors: Andreas D Knudsen; Andreas Fuchs; J Tobias Kühl; Ben A Arnold; Børge G Nordestgaard; Lars V Køber; Klaus F Kofoed Journal: Eur Radiol Date: 2018-05-03 Impact factor: 5.315