Interplay of Coronary Artery Calcium and Risk Factors for Predicting CVD/CHD Mortality: The CAC Consortium

JACC Cardiovasc Imaging. 2020 May;13(5):1175-1186. doi: 10.1016/j.jcmg.2019.08.024. Epub 2019 Nov 13.


Objectives: This study sought to evaluate the association and burden of coronary artery calcium (CAC) with long-term, cause-specific mortality across the spectrum of baseline risk.

Background: Although CAC is a known predictor of short-term, all-cause mortality, data on long-term and cause-specific mortality are inadequate.

Methods: The CAC Consortium cohort is a multicenter cohort of 66,636 participants without coronary heart disease (CHD) who underwent CAC testing. The following risk factors (RFs) were considered: 1) current cigarette smoking; 2) dyslipidemia; 3) diabetes mellitus; 4) hypertension; and 5) family history of CHD.

Results: During the 12.5-years median follow-up, 3,158 (4.7%) deaths occurred; 32% were cardiovascular disease (CVD) deaths. Participants with CAC scores ≥400 had a significantly increased risk for CHD and CVD mortality (hazard ratio [HR]: 5.44; 95% confidence interval [CI]: 3.88 to 7.62; and HR: 4.15; 95% CI: 3.29 to 5.22, respectively) compared with CAC of 0. Participants with ≥3 RFs had a smaller increased risk for CHD and CVD mortality (HR: 2.09; 95% CI: 1.52 to 2.85; and HR: 1.84; 95% CI: 1.46 to 2.31, respectively) compared with those without RFs. Across RF strata, CAC added prognostic information. For example, participants without RFs but with CAC ≥400 had significantly higher all-cause, non-CVD, CVD, and CHD mortality rates compared with participants with ≥3 RFs and CAC of 0.

Conclusions: Across the spectrum of RF burden, a higher CAC score was strongly associated with long-term, all-cause mortality and a greater proportion of deaths due to CVD and CHD. Absence of CAC identified people with a low risk over 12 years of follow-up, with most deaths being non-CVD in nature, regardless of RF burden.

Keywords: coronary artery calcium; mortal; risk factors.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Cause of Death
  • Computed Tomography Angiography*
  • Coronary Angiography*
  • Coronary Artery Disease / diagnostic imaging*
  • Coronary Artery Disease / mortality*
  • Diabetes Mellitus / mortality
  • Dyslipidemias / mortality
  • Female
  • Heart Disease Risk Factors
  • Humans
  • Hypertension / mortality
  • Male
  • Middle Aged
  • Multidetector Computed Tomography*
  • Predictive Value of Tests
  • Prevalence
  • Prognosis
  • Retrospective Studies
  • Risk Assessment
  • Smoking / adverse effects
  • Smoking / mortality
  • Time Factors
  • United States / epidemiology
  • Vascular Calcification / diagnostic imaging*
  • Vascular Calcification / mortality*