Coronary artery calcium predicts 5-year all-cause-, non-cardiovascular-, and cancer mortality
J Anderson, D S Collingridge, S Knight, V T Le, L Iverson, T L Bair, S M Mason, J B Muhlestein, K U KnowltonAbstract
Background
Coronary artery calcium (CAC) is a strong predictor of coronary artery disease (CAD) and global cardiovascular risk, and CAC=0 is a highly favorable prognostic marker. A few reports suggest that clinical CAD also may be associated with a greater risk of non-cardiovascular and cancer risk. Whether CAC as a preclinical marker of CAD similarly predicts non-CV risk is uncertain.
Objective
To determine whether CAC is prognostic of 5-year all-cause, non-cardiovascular- and cancer-related mortality.
Methods
We searched the institutional electronic medical record (eMR) database for patients (pts) at primary coronary risk who underwent positron emission tomography/computed tomography (PET/CT) stress testing and had a 5-year follow-up. Cause-specific mortality was determined by agnostic chart review. We compared unadjusted and age/sex-adjusted total and cause-specific mortality rates between CAC=0 and CAC>0 groups. Logistic regression was used to test for age/sex adjusted between-group odds ratio differences.
Results
The eMR search identified 40,006 pts undergoing PET/CT who were at primary coronary risk. Mean age was 65.8 [11.9] y; 48.7% were female; 7959 (19.9%) were CAC=0 by CT, and 32,047 were CAC>0. There were 230 deaths (2.89%) among CAC=0 and 2830 deaths (8.83%) among CAC>0 pts, for a relative risk (RR) of 3.06 for CAC>0 (p<0.001). The age/sex adjusted total mortality risk for CAC>0 was 2.11 (CI, 1.83-2.43, p<0.001). The unadjusted and adjusted risks for CV-, non-CV-, and cancer-related deaths are shown in Tables 1 and 2. CAC>0 predicted a greater risk of death not only for total mortality and CV-related mortality but also for non-CV and cancer-related death.
Conclusions
In this large, integrated healthcare system experience, the presence of CAC predicted a greater risk not only for CV-death but also for all-cause, non-CV, and cancer deaths. The implications of CAC go beyond marking the risk of CAD-related and all CV events to also marking global vascular health, cancer risk, and overall survival. The mechanisms of this association require further study, but CAC is a predictor of calcification in other vascular beds and may be a marker of multiorgan involvement in the cardiometabolic syndrome. CAD and CAC may impact cancer risk through altered immune surveillance.