Coronary Artery Calcium as a Synergistic Tool for the Age‐ and Sex‐Specific Risk of Cardiovascular and Cancer Mortality: The Coronary Artery Calcium Consortium

• Type of Material: Article
• Authors: Omar Dzaye, Johns Hopkins University; Mahmoud Al Rifai, Johns Hopkins University; Zeina Dardari, Johns Hopkins University; Leslee Shaw, Emory University; Mouaz H. Al-Mallah, Houston Methodist DeBakey Heart & Vascular Center; Catherine Handy Marshall, Sidney Kimmel Comprehensive Cancer Center; Alan Rozanski, Mount Sinai School of Medicine; Martin B. Mortensen, Aarhus University; Matthias Duebgen, Charité, Berlin; Kunihiro Matsushita, Johns Hopkins University; John A. Rumberger, Princeton Longevity Center; Daniel S. Berman, Cedars-Sinai Medical Center; Matthew J. Budoff, UCLA Medical Center; Michael D. Miedema, Minneapolis Heart Institute; Khurram Nasir, Johns Hopkins University; Michael J. Blaha, Johns Hopkins University; Seamus P. Whelton, Johns Hopkins University
• Language: English
• Date: 2020-04-21
• Publisher: Wiley
• Publication Version: Final Published Version
• Copyright Statement: © 2020 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1161/JAHA.119.015306
• Title of Journal or Parent Work: Journal of the American Heart Association
• Volume: 9
• Issue: 8
• Grant/Funding Information: Dr Whelton was supported by the American Heart Association Mentored Clinical and Population Research Award (17MCPRP33660247) and the PJ Schafer Memorial Foundation.
• Keywords: sex differences; coronary artery calcium; competing risk; aging; Imaging; Computerized Tomography (CT); cardiovascular disease
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Radiology; Health Sciences, Health Care Management

Abstract

Background Coronary artery calcium (CAC) is a predictor for the development of cardiovascular disease (CVD) and to a lesser extent cancer. The age‐ and sex‐specific relationship of CAC with CVD and cancer mortality is unknown. Methods and Results Asymptomatic patients aged 40 to 75 years old without known CVD were included from the CAC Consortium. We calculated sex‐specific mortality rates per 1000 person‐years’ follow‐up. Using parametric survival regression modeling, we determined the age‐ and sex‐specific CAC score at which the risk of death from CVD and cancer were equal. Among the 59 502 patients included in this analysis, the mean age was 54.9 (±8.5) years, 34% were women, and 89% were white. There were 671 deaths attributable to CVD and 954 deaths attributable to cancer over a mean follow‐up of 12±3 years. Among patients with CAC=0, cancer was the leading cause of death, the total mortality rate was low (women, 1.8; men, 1.5), and the CVD mortality rate was exceedingly low for women (0.3) and men (0.3). The age‐specific CAC score at which the risk of CVD and cancer mortality were equal had a U‐shaped relationship for women, while the relationship was exponential for men. Conclusions The age‐ and sex‐specific relationship of CAC with CVD and cancer mortality differed significantly for women and men. Our age‐ and sex‐specific CAC score provides a more precise estimate and further facilitates the use of CAC as a synergistic tool in strategies for the prediction and prevention of CVD and cancer mortality.