Allison W Peng1, Mohammadhassan Mirbolouk1, Olusola A Orimoloye1, Albert D Osei1, Zeina Dardari1, Omar Dzaye1, Matthew J Budoff2, Leslee Shaw3, Michael D Miedema4, John Rumberger5, Daniel S Berman6, Alan Rozanski7, Mouaz H Al-Mallah8, Khurram Nasir9, Michael J Blaha10. 1. Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, Maryland. 2. Department of Medicine, Harbor-UCLA Medical Center, University of California Los Angeles, Los Angeles, California. 3. Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia. 4. Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota. 5. Princeton Longevity Center, Princeton, New Jersey. 6. Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California. 7. Division of Cardiology, Mount Sinai St. Luke's Hospital, New York, New York. 8. Cardiovascular Imaging Department, Houston Methodist Hospital, Houston, Texas. 9. Section of Cardiovascular Medicine, Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, Connecticut. 10. Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, Maryland. Electronic address: mblaha1@jhmi.edu.
Abstract
OBJECTIVES: This study thoroughly explored the demographic and imaging characteristics, as well as the all-cause and cause-specific mortality risks of patients with a coronary artery calcium (CAC) score ≥1,000 in the largest dataset of this population to date. BACKGROUND: CAC is commonly used to quantify cardiovascular risk. Current guidelines classify a CAC score of >300 or 400 as the highest risk group, yet little is known about the potentially unique imaging characteristics and mortality risk in individuals with a CAC score ≥1,000. METHODS: A total of 66,636 asymptomatic adults were included from the CAC consortium, a large retrospective multicenter clinical cohort. Mean patient follow-up was 12.3 ± 3.9 years for patients with cardiovascular disease (CVD), coronary heart disease (CHD), cancer, and all-cause mortality. Multivariate Cox proportional hazards regression models adjusted for age, sex, and conventional risk factors were used to assess the relative mortality hazard of individuals with CAC ≥1,000 compared with, first, a CAC reference of 0, and second, with patients with a CAC score of 400 to 999. RESULTS: There were 2,869 patients with CAC ≥1,000 (86.3% male, mean 66.3 ± 9.7 years of age). Most patients with CAC ≥1,000 had 4-vessel CAC (mean: 3.5 ± 0.6 vessels) and had greater total CAC area, higher mean CAC density, and more extracoronary calcium (79% with thoracic artery calcium, 46% with aortic valve calcium, and 21% with mitral valve calcium) than those with CAC scores of 400 to 999. After full adjustment, those with CAC ≥1,000 had a 5.04- (95% confidence interval [CI]: 3.92 to 6.48), 6.79- (95% CI: 4.74 to 9.73), 1.55- (95% CI:1.23 to 1.95), and 2.89-fold (95% CI: 2.53 to 3.31) risk of CVD, CHD, cancer, and all-cause mortality, respectively, compared to those with CAC score of 0. The CAC ≥1,000 group had a 1.71- (95% CI: 1.41 to 2.08), 1.84- (95% CI: 1.43 to 2.36), 1.36- (95% CI:1.07 to 1.73), and 1.51-fold (95% CI: 1.33 to 1.70) increased risk of CVD, CHD, cancer, and all-cause mortality compared to those with CAC scores 400 to 999. Graphic analysis of CAC ≥1,000 patients revealed continued logarithmic increase in risk, with no clear evidence of a risk plateau. CONCLUSIONS: Patients with extensive CAC (CAC ≥1,000) represent a unique very high-risk phenotype with mortality outcomes commensurate with high-risk secondary prevention patients. Future guidelines should consider CAC ≥1,000 patients to be a distinct risk group who may benefit from the most aggressive preventive therapy.
OBJECTIVES: This study thoroughly explored the demographic and imaging characteristics, as well as the all-cause and cause-specific mortality risks of patients with a coronary artery calcium (CAC) score ≥1,000 in the largest dataset of this population to date. BACKGROUND: CAC is commonly used to quantify cardiovascular risk. Current guidelines classify a CAC score of >300 or 400 as the highest risk group, yet little is known about the potentially unique imaging characteristics and mortality risk in individuals with a CAC score ≥1,000. METHODS: A total of 66,636 asymptomatic adults were included from the CAC consortium, a large retrospective multicenter clinical cohort. Mean patient follow-up was 12.3 ± 3.9 years for patients with cardiovascular disease (CVD), coronary heart disease (CHD), cancer, and all-cause mortality. Multivariate Cox proportional hazards regression models adjusted for age, sex, and conventional risk factors were used to assess the relative mortality hazard of individuals with CAC ≥1,000 compared with, first, a CAC reference of 0, and second, with patients with a CAC score of 400 to 999. RESULTS: There were 2,869 patients with CAC ≥1,000 (86.3% male, mean 66.3 ± 9.7 years of age). Most patients with CAC ≥1,000 had 4-vessel CAC (mean: 3.5 ± 0.6 vessels) and had greater total CAC area, higher mean CAC density, and more extracoronary calcium (79% with thoracic artery calcium, 46% with aortic valve calcium, and 21% with mitral valve calcium) than those with CAC scores of 400 to 999. After full adjustment, those with CAC ≥1,000 had a 5.04- (95% confidence interval [CI]: 3.92 to 6.48), 6.79- (95% CI: 4.74 to 9.73), 1.55- (95% CI:1.23 to 1.95), and 2.89-fold (95% CI: 2.53 to 3.31) risk of CVD, CHD, cancer, and all-cause mortality, respectively, compared to those with CAC score of 0. The CAC ≥1,000 group had a 1.71- (95% CI: 1.41 to 2.08), 1.84- (95% CI: 1.43 to 2.36), 1.36- (95% CI:1.07 to 1.73), and 1.51-fold (95% CI: 1.33 to 1.70) increased risk of CVD, CHD, cancer, and all-cause mortality compared to those with CAC scores 400 to 999. Graphic analysis of CAC ≥1,000 patients revealed continued logarithmic increase in risk, with no clear evidence of a risk plateau. CONCLUSIONS:Patients with extensive CAC (CAC ≥1,000) represent a unique very high-risk phenotype with mortality outcomes commensurate with high-risk secondary prevention patients. Future guidelines should consider CAC ≥1,000 patients to be a distinct risk group who may benefit from the most aggressive preventive therapy.
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: Morgan Lamberg; Andrea Rossman; Alexandra Bennett; Sabrina Painter; Rachel Goodman; James MacLeod; Ragasnehith Maddula; David Rayan; Krishna Doshi; Alexander Bick; Simone Bailey; Sherry-Ann Brown Journal: Curr Atheroscler Rep Date: 2022-04-19 Impact factor: 5.113
Authors: Gianluca Pontone; Alexia Rossi; Marco Guglielmo; Marc R Dweck; Oliver Gaemperli; Koen Nieman; Francesca Pugliese; Pal Maurovich-Horvat; Alessia Gimelli; Bernard Cosyns; Stephan Achenbach Journal: Eur Heart J Cardiovasc Imaging Date: 2022-02-22 Impact factor: 6.875
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: Olufunmilayo H Obisesan; Minghao Kou; Frances M Wang; Ellen Boakye; Yasuyuki Honda; S M Iftekhar Uddin; Omar Dzaye; Albert D Osei; Olusola A Orimoloye; Candace M Howard-Claudio; Josef Coresh; Roger S Blumenthal; Ron C Hoogeveen; Matthew J Budoff; Kunihiro Matsushita; Christie M Ballantyne; Michael J Blaha Journal: J Am Heart Assoc Date: 2022-06-03 Impact factor: 6.106
Authors: Allison W Peng; Zeina A Dardari; Roger S Blumenthal; Omar Dzaye; Olufunmilayo H Obisesan; S M Iftekhar Uddin; Khurram Nasir; Ron Blankstein; Matthew J Budoff; Martin Bødtker Mortensen; Parag H Joshi; John Page; Michael J Blaha Journal: Circulation Date: 2021-03-02 Impact factor: 29.690
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: Cvetan Trpkov; Alexei Savtchenko; Zhiying Liang; Patrick Feng; Danielle A Southern; Stephen B Wilton; Matthew T James; Erin Feil; Ilias Mylonas; Robert J H Miller Journal: Int J Cardiol Heart Vasc Date: 2021-06-19