Introduction: Coronary artery calcium (CAC) reflects coronary plaque burden and independently predicts all-cause mortality. There is marked heterogeneity in the prognosis of individuals with a high burden of subclinical atherosclerosis, yet little research has focused on the proximate determinants of poor outcomes in this subgroup.
Methods: Among 4234 persons with baseline CAC ≥400, multivariable Cox proportional hazards models were used to study the association of traditional cardiovascular risk factors with 1-year all-cause mortality.
Results: The mean age was 64 ± 10 years, with 56% male and a median CAC score of 809 (IQR 761). In multivariable models, diabetes, cigarette smoking, age (per SD), CAC (per SD) and dyslipidemia were significantly associated with all-cause mortality at 1 year: HR (95% confidence interval) = 2.62 (1.55-4.43), 2.42 (1.41-4.15), 1.52 (1.16-1.99), 1.33 (CAC 1.11-1.56) and 0.58 (0.34-0.98) respectively. There was no association with hypertension [HR (95% confidence interval) = 0.90 (0.55-1.47)].
Conclusion: Smoking and diabetes are strongly associated with one-year all-cause mortality among persons with extensive CAC, perhaps suggesting that these risk factors serve as triggers of acute events.
Keywords: All-cause mortality; Cardiovascular risk factors; Subclinical atherosclerosis.
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