Coronary Artery Calcium and the Age-Specific Competing Risk of Cardiovascular Versus Cancer Mortality: The Coronary Artery Calcium Consortium - 28/09/20
, Mahmoud Al Rifai, MD, MPH a, Catherine Handy Marshall, MD, MPH a, b, Zeina Dardari, MS a, Leslee J. Shaw, PhD c, Mouaz H. Al-Mallah, MD d, Alan Rozanski, MD e, Martin B. Mortensen, MD PhD f, Omar Dzaye, MD PhD a, Lydia Bazzano, MD, PhD g, Tanika N. Kelly, PhD, MPH g, Kunihiro Matsushita, MD, PhD h, John A. Rumberger, MD, PhD i, Daniel S. Berman, MD j, Matthew J. Budoff, MD k, Michael D. Miedema, MD l, Khurram Nasir, MD, MPH a, m, Michael J. Blaha, MD, MPH aAbstract |
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.
El texto completo de este artículo está disponible en PDF.Keywords : Age, Competing risk, Coronary artery calcium, Risk prediction
Esquema
| Funding: SPW was supported by the American Heart Association Mentored Clinical and Population Research Award (17MCPRP33660247) and the PJ Schafer Memorial Foundation. |
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| Conflict of Interest: LJS has received grant support from the Antinori Foundation. MJ Budoff has received grant support from GE Healthcare. CHM has received grant support from Bristol Myers Squibb and travel support from DAVA Oncology. She also reports being a consultant for McGraw-Hill. All other authors have nothing to disclose. |
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| Authorship: All authors had access to the data and a role in writing this manuscript. |
Vol 133 - N° 10
P. e575-e583 - octobre 2020 Regresar al número
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