Ramzi Dudum1, Omar Dzaye2, Mohammadhassan Mirbolouk3, Zeina A Dardari3, Olusola A Orimoloye3, Matthew J Budoff4, Daniel S Berman5, Alan Rozanski6, Michael D Miedema7, Khurram Nasir8, John A Rumberger9, Leslee Shaw10, Seamus P Whelton1, Garth Graham11, Michael J Blaha12. 1. Department of Medicine, The Johns Hopkins Hospital, Baltimore, MD, USA; Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA. 2. Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA; Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Radiology and Neuroradiology, Charité, Berlin, Germany. 3. Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA. 4. Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA. 5. Department of Nuclear Cardiology/Cardiac Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA. 6. Department of Medicine, St. Luke's Roosevelt Hospital Center, New York, NY, USA. 7. Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN, USA. 8. Department of Medicine, Yale School of Medicine, New Haven, CT, USA; Center for Outcomes Research & Evaluation, Yale School of Medicine, New Haven, CT, USA. 9. Department of Cardiovascular Imaging, Princeton Longevity Center, Princeton, NJ, USA. 10. Department of Radiology and Medicine, Weill Cornell Medical College, New York, NY, USA. 11. Aetna Foundation, Hartford, CT, USA. 12. Department of Medicine, The Johns Hopkins Hospital, Baltimore, MD, USA; Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA. Electronic address: mblaha1@jhmi.edu.
Abstract
BACKGROUND: The Society of Cardiovascular Computed Tomography (SCCT) recommends consideration of coronary artery calcium (CAC) scoring among individuals with a family history (FH) of coronary heart disease (CHD) and atherosclerotic cardiovascular disease (ASCVD) risk <5%. No dedicated study has examined the prognostic significance of CAC scoring among this population. METHODS: The CAC Consortium is a multi-center observational cohort study from four clinical centers linked to long-term follow-up for cause-specific mortality. All CAC scans were physician referred and performed in patients without a history of CHD. Our analysis includes 14,169 patients with ASCVD scores <5% and self-reported FH of CHD. RESULTS: This cohort had a mean age of 48.1 (SD 7.4), was 91.3% white, 47.4% female, had an average ASCVD score of 2.3% (SD 1.3), and 59.4% had a CAC = 0. The event rate for all-cause mortality was 1.2 per 1000 person-years, 0.3 per 1000 person-years for CVD-specific mortality, and 0.2 per 1000 person-years for CHD-specific mortality. In multivariable Cox proportional hazard models, those with CAC>100 had a 2.2 (95% CI 1.5-3.3) higher risk of all-cause mortality, 4.3 (95% CI 1.9-9.5) times higher risk of CVD-specific mortality, and a 10.4 (95% CI 3.2-33.7) times higher risk of CHD-specific mortality compared to individuals with CAC = 0. The NNS to detect CAC >100 in this sample was 9. CONCLUSION: In otherwise low risk patients with FH of CHD, CAC>100 were associated with increased risk of all-cause and CHD mortality with event rates in a range that may benefit with preventive pharmacotherapy. These data strongly support new SCCT recommendations regarding testing of patients with a family history of CHD.
BACKGROUND: The Society of Cardiovascular Computed Tomography (SCCT) recommends consideration of coronary artery calcium (CAC) scoring among individuals with a family history (FH) of coronary heart disease (CHD) and atherosclerotic cardiovascular disease (ASCVD) risk <5%. No dedicated study has examined the prognostic significance of CAC scoring among this population. METHODS: The CAC Consortium is a multi-center observational cohort study from four clinical centers linked to long-term follow-up for cause-specific mortality. All CAC scans were physician referred and performed in patients without a history of CHD. Our analysis includes 14,169 patients with ASCVD scores <5% and self-reported FH of CHD. RESULTS: This cohort had a mean age of 48.1 (SD 7.4), was 91.3% white, 47.4% female, had an average ASCVD score of 2.3% (SD 1.3), and 59.4% had a CAC = 0. The event rate for all-cause mortality was 1.2 per 1000 person-years, 0.3 per 1000 person-years for CVD-specific mortality, and 0.2 per 1000 person-years for CHD-specific mortality. In multivariable Cox proportional hazard models, those with CAC>100 had a 2.2 (95% CI 1.5-3.3) higher risk of all-cause mortality, 4.3 (95% CI 1.9-9.5) times higher risk of CVD-specific mortality, and a 10.4 (95% CI 3.2-33.7) times higher risk of CHD-specific mortality compared to individuals with CAC = 0. The NNS to detect CAC >100 in this sample was 9. CONCLUSION: In otherwise low risk patients with FH of CHD, CAC>100 were associated with increased risk of all-cause and CHD mortality with event rates in a range that may benefit with preventive pharmacotherapy. These data strongly support new SCCT recommendations regarding testing of patients with a family history of CHD.
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