Mahmoud Al Rifai1, John W McEvoy1, Khurram Nasir2, Jon Rumberger3, David Feldman1, Matthew J Budoff4, Michael J Blaha1. 1. The Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Baltimore, MD, USA. 2. The Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Baltimore, MD, USA; Center for Prevention and Wellness, Baptist Health South Florida, Miami, FL, USA. 3. Princeton Longevity Center, Princeton, NJ, USA. 4. Division of Cardiology, Harbor-UCLA Medical Center, Torrance, CA, USA.
Abstract
INTRODUCTION: Coronary artery calcium (CAC) reflects coronary plaque burden and independently predicts all-cause mortality. There is marked heterogeneity in the prognosis of individuals with a high burden of subclinical atherosclerosis, yet little research has focused on the proximate determinants of poor outcomes in this subgroup. METHODS: Among 4234 persons with baseline CAC ≥400, multivariable Cox proportional hazards models were used to study the association of traditional cardiovascular risk factors with 1-year all-cause mortality. RESULTS: The mean age was 64 ± 10 years, with 56% male and a median CAC score of 809 (IQR 761). In multivariable models, diabetes, cigarette smoking, age (per SD), CAC (per SD) and dyslipidemia were significantly associated with all-cause mortality at 1 year: HR (95% confidence interval) = 2.62 (1.55-4.43), 2.42 (1.41-4.15), 1.52 (1.16-1.99), 1.33 (CAC 1.11-1.56) and 0.58 (0.34-0.98) respectively. There was no association with hypertension [HR (95% confidence interval) = 0.90 (0.55-1.47)]. CONCLUSION: Smoking and diabetes are strongly associated with one-year all-cause mortality among persons with extensive CAC, perhaps suggesting that these risk factors serve as triggers of acute events.
INTRODUCTION: Coronary artery calcium (CAC) reflects coronary plaque burden and independently predicts all-cause mortality. There is marked heterogeneity in the prognosis of individuals with a high burden of subclinical atherosclerosis, yet little research has focused on the proximate determinants of poor outcomes in this subgroup. METHODS: Among 4234 persons with baseline CAC ≥400, multivariable Cox proportional hazards models were used to study the association of traditional cardiovascular risk factors with 1-year all-cause mortality. RESULTS: The mean age was 64 ± 10 years, with 56% male and a median CAC score of 809 (IQR 761). In multivariable models, diabetes, cigarette smoking, age (per SD), CAC (per SD) and dyslipidemia were significantly associated with all-cause mortality at 1 year: HR (95% confidence interval) = 2.62 (1.55-4.43), 2.42 (1.41-4.15), 1.52 (1.16-1.99), 1.33 (CAC 1.11-1.56) and 0.58 (0.34-0.98) respectively. There was no association with hypertension [HR (95% confidence interval) = 0.90 (0.55-1.47)]. CONCLUSION: Smoking and diabetes are strongly associated with one-year all-cause mortality among persons with extensive CAC, perhaps suggesting that these risk factors serve as triggers of acute events.
Authors: Ali M Alshahrani; Hamza Mahmood; George A Wells; Alomgir Hossain; Frank J Rybicki; Stephan Achenbach; Mouaz H Al-Mallah; Daniele Andreini; Jeroen J Bax; Daniel S Berman; Matthew J Budoff; Filippo Cademartiri; Tracy Q Callister; Hyuk-Jae Chang; Kavitha Chinnaiyan; Ricardo C Cury; Augustin DeLago; Gudrun Feuchtner; Martin Hadamitzky; Joerg Hausleiter; Philipp A Kaufmann; Yong-Jin Kim; Jonathon A Leipsic; Erica Maffei; Hugo Marques; Gianluca Pontone; Gilbert Raff; Ronen Rubinshtein; Leslee J Shaw; Todd C Villines; Fay Y Lin; James K Min; Benjamin J Chow Journal: Circ Cardiovasc Imaging Date: 2019-09-17 Impact factor: 7.792