Seamus P Whelton1, Mahmoud Al Rifai2, Catherine Handy Marshall3, Zeina Dardari2, Leslee J Shaw4, Mouaz H Al-Mallah5, Alan Rozanski6, Martin B Mortensen7, Omar Dzaye2, Lydia Bazzano8, Tanika N Kelly8, Kunihiro Matsushita9, John A Rumberger10, Daniel S Berman11, Matthew J Budoff12, Michael D Miedema13, Khurram Nasir14, Michael J Blaha2. 1. Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Md. Electronic address: seamus.whelton@jhmi.edu. 2. Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Md. 3. Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Md; Sidney Kimmel Comprehensive Cancer Center, Baltimore, Md. 4. Weill Cornell Medical College, New York, NY. 5. Houston Methodist Hospital, Houston, TX. 6. Division of Cardiology, Mount Sinai, St Luke's Hospital, New York, NY. 7. Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. 8. Tulane University School of Public Health and Tropical Medicine, New Orleans, La. 9. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md. 10. Princeton Longevity Center, Princeton, NJ. 11. Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, Calif. 12. Department of Medicine, Harbor UCLA Medical Center, Los Angeles, Calif. 13. Minneapolis Heart Institute and Foundation, Minneapolis, Minn. 14. Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Md; Center for Outcomes Research and Evaluation, Yale University, New Haven, Conn.
Abstract
BACKGROUND: Coronary artery calcium (CAC) is a guideline recommended cardiovascular disease (CVD) risk stratification tool that increases with age and is associated with non-cardiovascular disease outcomes including cancer. We sought to define the age-specific change in the association between CAC and cause-specific mortality. METHODS: The Coronary Artery Calcium Consortium includes 59,502 asymptomatic patients age 40-75 without known CVD. Age-stratified mortality rates and parametric survival regression modeling was performed to estimate the age-specific CAC score at which CVD and cancer mortality risk were equal. RESULTS: The mean age was 54±8 years (67% men) and there were 2,423 deaths over a mean 12±3 years follow-up. Among individuals with CAC = 0, cancer was the leading cause of death, with low CVD mortality rates for both younger (40-54 years) 0.2/1,000 person-years and older participants (65-75 years) 1.3/1,000 person-years. When CAC ≥400, CVD was consistently the leading cause of death among younger (71% of deaths) and older participants (56% of deaths). The CAC score at which CVD overtook cancer as the leading cause of death increased exponentially with age and was approximately 115 at age 50 and 380 at age 65. CONCLUSIONS: Regardless of age, when CAC = 0 cancer was the leading cause of death and the cardiovascular disease mortality rate was low. Our age-specific estimate for the CAC score at which CVD overtakes cancer mortality allows for a more precise approach to synergistic prediction and prevention strategies for CVD and cancer.
BACKGROUND: Coronary artery calcium (CAC) is a guideline recommended cardiovascular disease (CVD) risk stratification tool that increases with age and is associated with non-cardiovascular disease outcomes including cancer. We sought to define the age-specific change in the association between CAC and cause-specific mortality. METHODS: The Coronary Artery Calcium Consortium includes 59,502 asymptomatic patients age 40-75 without known CVD. Age-stratified mortality rates and parametric survival regression modeling was performed to estimate the age-specific CAC score at which CVD and cancer mortality risk were equal. RESULTS: The mean age was 54±8 years (67% men) and there were 2,423 deaths over a mean 12±3 years follow-up. Among individuals with CAC = 0, cancer was the leading cause of death, with low CVD mortality rates for both younger (40-54 years) 0.2/1,000 person-years and older participants (65-75 years) 1.3/1,000 person-years. When CAC ≥400, CVD was consistently the leading cause of death among younger (71% of deaths) and older participants (56% of deaths). The CAC score at which CVD overtook cancer as the leading cause of death increased exponentially with age and was approximately 115 at age 50 and 380 at age 65. CONCLUSIONS: Regardless of age, when CAC = 0 cancer was the leading cause of death and the cardiovascular disease mortality rate was low. Our age-specific estimate for the CAC score at which CVD overtakes cancer mortality allows for a more precise approach to synergistic prediction and prevention strategies for CVD and cancer.
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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: Frances M Wang; Cara Reiter-Brennan; Zeina Dardari; Catherine H Marshall; Khurram Nasir; Michael D Miedema; Daniel S Berman; Alan Rozanski; John A Rumberger; Matthew J Budoff; Omar Dzaye; Michael J Blaha Journal: Am J Prev Cardiol Date: 2020-11-12
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