Seamus P Whelton1, Mahmoud Al Rifai1, Zeina Dardari1, Leslee J Shaw2, Mouaz H Al-Mallah3, Kunihiro Matsushita4, John A Rumberger5, Daniel S Berman6, Matthew J Budoff7, Michael D Miedema8, Khurram Nasir1,9, Michael J Blaha1. 1. Department of Medicine, Division of Cardiology, Johns Hopkins Ciccarone Center for Prevention of Heart Disease, 600 North Wolfe Street, Blalock 524A, Baltimore, MD, USA. 2. Department of Medicine, Emory University School of Medicine, 1648 Pierce Drive, Atlanta, GA, USA. 3. King Abdul-Aziz Cardiac Center, Riyadh, Saudi Arabia. 4. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument St, Baltimore, MD, USA. 5. Princeton Longevity Center, 136 Main St, Princeton, NJ, USA. 6. Department of Imaging, Cedars-Sinai Medical Center, 8705 Gracie Allen Dr, Los Angeles, LA, USA. 7. Department of Medicine, Harbor UCLA Medical Center, 1000 W Carson St, Torrance, CA, USA. 8. Minneapolis Heart Institute and Foundation, Abbott Northwestern Hospital, 800 E. 8th St, Minneapolis, MN, USA. 9. Center for Prevention and Wellness, Baptist Health South Florida, Miami, FL, USA.
Abstract
AIMS: Coronary artery calcium (CAC) is the strongest predictor of cardiovascular disease (CVD), yet is also associated with chronic non-CVD such as cancer. We performed this analysis in order to describe the association of CAC with CVD vs. cancer mortality. METHODS AND RESULTS: The CAC Consortium is comprised of 66 636 scans performed in asymptomatic patients without known CVD. The mean age was 54 ± 11 years and 67% of participants were men. Cause of death was ascertained from death certificates. The association of CAC with cause-specific mortality was calculated using Fine and Gray sub-distribution hazard ratio (SHR) models, which account for competing causes of death. There were 3158 deaths over a median 12 ± 4 years follow-up (37% cancer and 32% CVD). Cancer was the leading cause of death when CAC = 0 (50%) with CVD overtaking cancer when baseline CAC >300. Compared to participants with CAC = 0, the SHR for CVD mortality was 1.44 [95% confidence interval (CI) 1.14-1.81], 2.26 (95% CI 1.76-2.90), and 3.68 (95% CI 2.90-4.67) for patients with CAC 1-99, 100-299, and ≥300, and the SHR for cancer was 1.04 (95% CI 0.88-1.23), 1.19 (95% CI 0.98-1.46), and 1.30 (95% CI 1.07-1.58). CONCLUSION: Cancer was the leading cause of death for patients with baseline CAC = 0, whereas CVD overtook cancer above a threshold of CAC >300. These results argue for a focused approach for patients at the extremes of CAC scoring while suggesting that combined CVD and cancer primary prevention strategies for patients with intermediate CAC scores may significantly decrease mortality from the two leading causes of death. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Coronary artery calcium (CAC) is the strongest predictor of cardiovascular disease (CVD), yet is also associated with chronic non-CVD such as cancer. We performed this analysis in order to describe the association of CAC with CVD vs. cancer mortality. METHODS AND RESULTS: The CAC Consortium is comprised of 66 636 scans performed in asymptomatic patients without known CVD. The mean age was 54 ± 11 years and 67% of participants were men. Cause of death was ascertained from death certificates. The association of CAC with cause-specific mortality was calculated using Fine and Gray sub-distribution hazard ratio (SHR) models, which account for competing causes of death. There were 3158 deaths over a median 12 ± 4 years follow-up (37% cancer and 32% CVD). Cancer was the leading cause of death when CAC = 0 (50%) with CVD overtaking cancer when baseline CAC >300. Compared to participants with CAC = 0, the SHR for CVD mortality was 1.44 [95% confidence interval (CI) 1.14-1.81], 2.26 (95% CI 1.76-2.90), and 3.68 (95% CI 2.90-4.67) for patients with CAC 1-99, 100-299, and ≥300, and the SHR for cancer was 1.04 (95% CI 0.88-1.23), 1.19 (95% CI 0.98-1.46), and 1.30 (95% CI 1.07-1.58). CONCLUSION:Cancer was the leading cause of death for patients with baseline CAC = 0, whereas CVD overtook cancer above a threshold of CAC >300. These results argue for a focused approach for patients at the extremes of CAC scoring while suggesting that combined CVD and cancer primary prevention strategies for patients with intermediate CAC scores may significantly decrease mortality from the two leading causes of death. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Siegfried Adelhoefer; S M Iftekhar Uddin; Albert D Osei; Olufunmilayo H Obisesan; Michael J Blaha; Omar Dzaye Journal: Radiol Cardiothorac Imaging Date: 2020-12-17
Authors: Omar Dzaye; Philipp Berning; Zeina A Dardari; Daniel S Berman; Matthew J Budoff; Michael D Miedema; Khurram Nasir; Alan Rozanski; John A Rumberger; Leslee J Shaw; Martin Bødtker Mortensen; Seamus P Whelton; Michael J Blaha Journal: Atherosclerosis Date: 2021-10-18 Impact factor: 5.162
Authors: Seamus P Whelton; Catherine Handy Marshall; Miguel Cainzos-Achirica; Omar Dzaye; Roger S Blumenthal; Khurram Nasir; Robyn L McClelland; Michael J Blaha Journal: Am J Prev Cardiol Date: 2021-06-14
Authors: Omar Dzaye; Philipp Berning; Zeina A Dardari; Martin Bødtker Mortensen; Catherine Handy Marshall; Khurram Nasir; Matthew J Budoff; Roger S Blumenthal; Seamus P Whelton; Michael J Blaha Journal: Eur Heart J Cardiovasc Imaging Date: 2022-04-18 Impact factor: 9.130
Authors: Omar Dzaye; Mahmoud Al Rifai; Zeina Dardari; Leslee J Shaw; Mouaz H Al-Mallah; Catherine Handy Marshall; Alan Rozanski; Martin B Mortensen; Matthias Duebgen; Kunihiro Matsushita; John A Rumberger; Daniel S Berman; Matthew J Budoff; Michael D Miedema; Khurram Nasir; Michael J Blaha; Seamus P Whelton Journal: J Am Heart Assoc Date: 2020-04-20 Impact factor: 5.501
Authors: Michelle C Williams; Jonathan Weir-McCall; Alastair J Moss; Matthias Schmitt; James Stirrup; Ben Holloway; Deepa Gopalan; Aparna Deshpande; Gareth Morgan Hughes; Bobby Agrawal; Edward Nicol; Giles Roditi; James Shambrook; Russell Bull Journal: BJR Open Date: 2022-03-11
Authors: Seamus P Whelton; Mahmoud Al Rifai; Catherine Handy Marshall; Zeina Dardari; Leslee J Shaw; Mouaz H Al-Mallah; Alan Rozanski; Martin B Mortensen; Omar Dzaye; Lydia Bazzano; Tanika N Kelly; Kunihiro Matsushita; John A Rumberger; Daniel S Berman; Matthew J Budoff; Michael D Miedema; Khurram Nasir; Michael J Blaha Journal: Am J Med Date: 2020-04-05 Impact factor: 4.965