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Absence of Coronary Artery Calcification and All-Cause Mortality
- Source :
- JACC: Cardiovascular Imaging. (6):692-700
- Publisher :
- American College of Cardiology Foundation. Published by Elsevier Inc.
-
Abstract
- Objectives We sought to quantify the mortality rates associated with absent and low positive (CAC 1 to 10) coronary artery calcium (CAC). Background There is increasing interest in the absence of CAC as a “negative” cardiovascular risk factor. However, published event rates for individuals with no CAC vary, likely owing to differences in baseline risk, follow-up period, and outcome ascertainment. The prognostic significance of low CAC (CAC 1 to 10) is not well described. Methods Annualized all-cause mortality rates were assessed in 44,052 consecutive asymptomatic patients referred for CAC testing. Mean follow-up of the cohort was 5.6 ± 2.6 years (range 1 to 13 years). Results A total of 19,898 patients (45%) had no CAC on screening electron beam tomography, whereas 5,388 (12%) had low levels of CAC (CAC 1 to 10), and 18,766 (43%) had CAC >10. There were 104 deaths in those with no CAC (0.52%), 58 deaths in those with CAC 1 to 10 (1.06%), and 739 deaths in those with CAC >10 (3.96%). Annualized all-cause mortality rates for CAC = 0, CAC 1 to 10, and CAC >10 were 0.87, 1.92, and 7.48 deaths/1,000 person-years, respectively. The hazard ratio (HR) for all-cause mortality among CAC 1 to 10 versus CAC = 0 after adjustment for traditional risk factors was 1.99 (95% confidence interval [CI]: 1.44 to 2.75). Smoking (HR: 3.97, 95% CI: 2.75 to 5.41) and diabetes mellitus (HR: 3.36, 95% CI: 2.09 to 5.41) were associated with few events observed in CAC = 0 group. Conclusions In appropriately selected asymptomatic patients, the absence of CAC predicts excellent survival with 10-year event rates of approximately 1%. A finding of 0 CAC might be used as a rationale to emphasize lifestyle therapies rather than pharmacotherapy and to forgo repeated imaging studies. Individuals with low CAC score (CAC 1 to 10) are at increased risk above individuals with a 0 score and could be considered a distinct risk group by physicians and investigators.
- Subjects :
- Male
medicine.medical_specialty
endocrine system diseases
electron beam tomography
Coronary Artery Disease
Electron beam tomography
Asymptomatic
Risk Factors
Internal medicine
Cause of Death
medicine
Humans
Radiology, Nuclear Medicine and imaging
cardiovascular diseases
Risk factor
coronary artery calcium
Cause of death
Aged
medicine.diagnostic_test
business.industry
Mortality rate
Hazard ratio
Calcinosis
nutritional and metabolic diseases
Middle Aged
Prognosis
Survival Analysis
Confidence interval
Surgery
Radiography
Alfaxalone Alfadolone Mixture
Radiology Nuclear Medicine and imaging
Cohort
Cardiology
cardiovascular system
population characteristics
mortality risk
Female
medicine.symptom
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- Language :
- English
- ISSN :
- 1936878X
- Issue :
- 6
- Database :
- OpenAIRE
- Journal :
- JACC: Cardiovascular Imaging
- Accession number :
- edsair.doi.dedup.....073bae29562ec3f041ef2c8bf4ff4af8
- Full Text :
- https://doi.org/10.1016/j.jcmg.2009.03.009