Search

Objectives This study aimed to assess the long-term risk of death and atherosclerotic cardiovascular disease (ASCVD) outcomes, including stroke, in a real-world cohort that underwent coronary artery calcium (CAC) scoring. Background Large-scale, long-term studies assessing the independent relationship of CAC for prediction of ASCVD events, to include stroke, in young, low-risk patients are uncommon outside of the clinical trial setting. Methods A total of 23,637 consecutive subjects without ASCVD who underwent CAC scoring from 1997 to 2009 were studied. Subjects were assessed for myocardial infarction (MI), stroke, major adverse cardiovascular events (MACE) (e.g., MI, stroke, or cardiovascular death), and all-cause mortality. Outcomes were extracted from the Military Data Repository and the National Death Index and assessed using Cox proportional hazards models, controlling for baseline risk factors, atrial fibrillation, and competing mortality. Results Patients (mean age 50.0 ± 8.5 years) were followed over a median of 11.4 years. The relative adjusted subhazard ratio (aSHR) for CAC 1 to 100, 101 to 400, and >400 was 2.2, 3.8, and 5.9 for MI; 1.2, 1.4, and 1.9 for stroke; 1.4, 2.0, and 2.8 for MACE; and 1.2, 1.5 and 2.1 for death (p 0; n = 848) was associated with an increased risk of MACE (aSHR: 1.67; 95% confidence interval: 1.16 to 2.39). Conclusions CAC scoring significantly improved long-term prognostic accuracy for MACE events and mortality, irrespective of age and risk factors. These results support CAC screening for improving individual ASCVD risk assessment and prevention in low-risk, young adults.

BACKGROUND: Compared to traditional risk factors, coronary artery calcium (CAC) scores improve prognostic accuracy for atherosclerotic cardiovascular disease (ASCVD) outcomes. However, the relative impact of statins on ASCVD outcomes stratified by CAC scores is unknown. OBJECTIVES: To determine if CAC can identify patients most likely to benefit from statin treatment. METHODS: We identified consecutive subjects without pre-existing ASCVD or malignancy who underwent CAC scoring from 2002 to 2009 at Walter Reed. The primary outcome was first major adverse cardiovascular event (MACE), a composite of acute myocardial infarction, stroke, and cardiovascular death. The effect of statin therapy on outcomes was analyzed stratified by CAC presence and severity, after adjusting for baseline comorbidities with inverse probability of treatment weights based on propensity scores. RESULTS: 13,644 patients (mean age 50 years; 71% men) were followed for a median of 9.4 years. Comparing patients with and without statin exposure, statin therapy was associated with reduced risk of MACE in patients with CAC (adjusted subhazard ratio [aSHR] 0.76, 95% CI 0.60–0.95, p=0.015) but not in patients without CAC (aSHR 1.00, 95% CI 0.79–1.27, p=0.99). The effect of statin use on MACE was significantly related to the severity of CAC (p 100). CONCLUSIONS: In a large-scale cohort without baseline ASCVD, the presence and severity of CAC identified patients most likely to benefit from statins for the primary prevention of cardiovascular diseases. CONDENSED ABSTRACT: Prior studies have shown that coronary artery calcium (CAC) screening improves risk prediction of atherosclerotic cardiovascular disease (ASCVD), but the true impact of statins on ASCVD outcomes stratified by CAC scores is unknown. In this retrospective cohort of 13,644 patients without pre-existing atherosclerotic cardiovascular disease or malignancy who underwent CAC scoring at Walter Reed Army Medical Center, increasing severity of CAC was associated with increased benefit from statin treatment for the prevention of cardiovascular morbidity and mortality. CAC presence and severity may help stratify patients most likely to benefit from statins.

This study aimed to assess the long-term risk of death and atherosclerotic cardiovascular disease (ASCVD) outcomes, including stroke, in a real-world cohort that underwent coronary artery calcium (CAC) scoring.Large-scale, long-term studies assessing the independent relationship of CAC for prediction of ASCVD events, to include stroke, in young, low-risk patients are uncommon outside of the clinical trial setting.A total of 23,637 consecutive subjects without ASCVD who underwent CAC scoring from 1997 to 2009 were studied. Subjects were assessed for myocardial infarction (MI), stroke, major adverse cardiovascular events (MACE) (e.g., MI, stroke, or cardiovascular death), and all-cause mortality. Outcomes were extracted from the Military Data Repository and the National Death Index and assessed using Cox proportional hazards models, controlling for baseline risk factors, atrial fibrillation, and competing mortality.Patients (mean age 50.0 ± 8.5 years) were followed over a median of 11.4 years. The relative adjusted subhazard ratio (aSHR) for CAC 1 to 100, 101 to 400, and400 was 2.2, 3.8, and 5.9 for MI; 1.2, 1.4, and 1.9 for stroke; 1.4, 2.0, and 2.8 for MACE; and 1.2, 1.5 and 2.1 for death (p 0.0001). The addition of CAC score to risk factors significantly improved the prognostic accuracy for all outcomes by the likelihood ratio test. Area under the curve increased from 0.658 to 0.738 for MI, 0.703 to 0.704 for stroke, 0.685 to 0.705 for MACE, and 0.759 to 0.767 for mortality. Among subjects without traditional risk factors (n = 6,208; mean age 43.8 ± 4.4 years), the presence of any CAC (0; n = 848) was associated with an increased risk of MACE (aSHR: 1.67; 95% confidence interval: 1.16 to 2.39).CAC scoring significantly improved long-term prognostic accuracy for MACE events and mortality, irrespective of age and risk factors. These results support CAC screening for improving individual ASCVD risk assessment and prevention in low-risk, young adults.

While coronary artery calcium progression is predictive of cardiovascular outcomes, the optimal definition of CAC progression remains unclear, and the impact of statins on CAC progression is not fully understood. We sought to better define measures of CAC progression that were most associated with

The absence of coronary artery calcium (CAC) has been shown to be a strong negative risk factor for cardiovascular events; though, there is limited data on the optimal time interval for re-assessing for development of CAC on future scans. A previous study suggested that patients rarely convert from

Introduction: Current risk assessment guidelines focus on prevention of atherosclerotic cardiovascular disease (ASCVD), which includes stroke as a primary outcome variable. The long-term (>10 year) relationship of coronary artery calcium (CAC) scoring with stroke has not been previously reported, a limitation cited by the guidelines. Further, large-scale, long-term outcomes studies following CAC are limited. We sought to define the long-term relationship of CAC for stroke and myocardial infarction (MI) in a large screening cohort. Methods: We retrospectively identified 24,246 subjects (mean age 50±8; 70.5% men) without ASCVD or malignancy who underwent CAC scoring (Agatston) at Walter Reed Medical Center from 1997-2009. Subjects were assessed for the primary outcomes of MI and stroke and the secondary outcome of late (>90 days post CAC) coronary revascularization. Outcomes were extracted from the military data repository, a comprehensive healthcare database that captures care provided within and outside of the military healthcare system, and then analyzed using Cox proportional hazard multivariate stepwise regression controlling for baseline risk factors. Results: With a mean follow-up of 11.3±3.6 years there were 546 MI, 947 strokes and 843 late coronary revascularizations. Compared to subjects with no CAC, the adjusted hazard ratios (aHR) for MI were 2.09 (95% CI, 1.68-2.60), 2.01 (1.78-2.28) and 1.91 (1.72-2.11) for CAC scores of 1-100, 101-400 and >400, respectively. CAC of 1-100 was not predictive of stroke compared to no CAC. The aHRs of incident stroke were 1.15 (1.03-1.28) and 1.23 (1.13-1.33) for CAC scores of 101-400 and >400. CAC was strongly associated with late coronary revascularizations. CAC explained the most variance in models for MI and late revascularization and was the third most important predictor for stroke behind age and hypertension. Conclusion: In patients without ASCVD, CAC was a stronger independent predictor of incident MI and late coronary artery revascularization as compared to stroke over one of the longest follow-up intervals reported to date. Advanced CAC (>100) was a modest independent predictor of stroke during the study period. These results support the role of CAC for the prediction of incident ASCVD outcomes.