Coronary Artery Calcium and the Age-Specific Competing Risk of Cardiovascular Versus Cancer Mortality: The Coronary Artery Calcium Consortium

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-spe...

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Veröffentlicht in:The American journal of medicine 2020-10, Vol.133 (10), p.e575-e583
Hauptverfasser: Whelton, Seamus P., Rifai, Mahmoud Al, Marshall, Catherine Handy, Dardari, Zeina, Shaw, Leslee J., Al-Mallah, Mouaz H., Rozanski, Alan, Mortensen, Martin B., Dzaye, Omar, Bazzano, Lydia, Kelly, Tanika N., Matsushita, Kunihiro, Rumberger, John A., Berman, Daniel S., Budoff, Matthew J., Miedema, Michael D., Nasir, Khurram, Blaha, Michael J.
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container_end_page e583
container_issue 10
container_start_page e575
container_title The American journal of medicine
container_volume 133
creator Whelton, Seamus P.
Rifai, Mahmoud Al
Marshall, Catherine Handy
Dardari, Zeina
Shaw, Leslee J.
Al-Mallah, Mouaz H.
Rozanski, Alan
Mortensen, Martin B.
Dzaye, Omar
Bazzano, Lydia
Kelly, Tanika N.
Matsushita, Kunihiro
Rumberger, John A.
Berman, Daniel S.
Budoff, Matthew J.
Miedema, Michael D.
Nasir, Khurram
Blaha, Michael J.
description 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. 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. 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. 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.
doi_str_mv 10.1016/j.amjmed.2020.02.034
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subjects Adult
Age
Aged
Cardiac-Gated Imaging Techniques
Cardiovascular Diseases - mortality
Cause of Death
Competing risk
Coronary artery calcium
Coronary Artery Disease - diagnostic imaging
Female
Humans
Male
Middle Aged
Neoplasms - mortality
Risk Assessment
Risk prediction
Severity of Illness Index
Tomography, X-Ray Computed
Vascular Calcification - diagnostic imaging
title Coronary Artery Calcium and the Age-Specific Competing Risk of Cardiovascular Versus Cancer Mortality: The Coronary Artery Calcium Consortium
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