Coronary Artery Calcium to Predict All-Cause Mortality in Elderly Men and Women

Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
Journal of the American College of Cardiology (Impact Factor: 15.34). 07/2008; 52(1):17-23. DOI: 10.1016/j.jacc.2008.04.004
Source: PubMed

ABSTRACT We sought to study the prognostic utility of coronary artery calcium (CAC) in the elderly.
The prognostic significance of CAC in the elderly is not well known.
All-cause mortality was assessed in 35,388 patients (3,570 were >or=70 years old at screening, and 50% were women) after a mean follow-up of 5.8 +/- 3 years.
In older patients, risk factors and CAC were more prevalent. Overall survival was 97.9% at the end of follow-up. Mortality increased with each age decile with a relative hazard of 1.09 (95% confidence interval: 1.08 to 1.10, p < 0.0001), and rates were greater for men than women (hazard ratio: 1.53; 95% confidence interval: 1.32 to 1.77, p < 0.0001). Increasing CAC scores were associated with decreasing survival across all age deciles (p < 0.0001). Survival for a <40-year and >or=80-year-old man with a CAC score >or=400 was 88% and 19% (95% and 44% for a woman, p < 0.0001), respectively. Among the 20,562 patients with no CAC, annual mortality rates ranged from 0.3% to 2.2% for patients age 40 to 49 years or >or=70 years (p < 0.0001). The use of CAC allowed us to reclassify more than 40% of the patients >or=70 years old more often by excluding risk (i.e., CAC <400) in those with >3 risk factors.
Despite their limited life expectancy, the use of CAC discriminates mortality risk in the elderly. Furthermore, the use of CAC allows physicians to reclassify risk in the elderly.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Smaller coronary artery diameter portends worse outcomes after coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). The suggestion that women have smaller coronary artery diameters than men has not been validated by a large-scale study.HypothesisWe sought to confirm a gender difference with respect to coronary artery diameter, even after accounting for body habitus and left ventricular mass (LVM).Methods From 4200 subjects evaluated for cardiovascular disease by computed tomography angiography, we selected 710 subjects (383 males, 327 females) with coronary artery calcium (CAC) scores <100, eliminating patients with artery remodeling. Diameters of the left main (LM), left anterior descending (LAD), left circumflex (CX), and right coronary arteries (RCA), were measured. Measurements were compared using a 2-sample t test and the multiple regression model, accounting for body habitus and LVM.ResultsAfter adjusting for age, race, weight, height, body mass index, body surface index, LVM, and CAC, women have smaller diameters in the LM (males 4.35 mm, females 3.91 mm), LAD (males 3.54 mm, females 3.24 mm), CX (males 3.18, females 2.75 mm), and RCA (males 3.70 mm, females 3.26 mm) (P < 0.001). This difference is not related to body habitus or LVM.Conclusions Gender significantly influences artery diameter of the LM, LAD, CX, and RCA. This may warrant gender specific approaches during PCI and CABG. As neither body habitus nor LVM relate to the difference in coronary artery diameter, our study encourages a search for inherent differences between genders that can account for this difference.
    Clinical Cardiology 09/2014; 37(10). DOI:10.1002/clc.22310 · 2.23 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background and Aims: There is little information supporting the relationships between macronutrients and pre-clinical atherosclerosis. The aim of this study was to identify whether dietary macronutrient content is related with CAC. Methods: 10,793 healthy Korean adults in a cohort were enrolled. Subjects were divided into CAC (CAC score >0) or non-CAC group (CAC score = 0). Intake of energy, carbohydrate (CHO), protein and fat were obtained using food frequency questionnaire (FFQ). Macronutrient composition was expressed as the ratio of energy from each macronutrient to total energy. Subjects were classified into three groups according to tertiles of intake for each macronutrient. To investigate the association between macronutrient intake and CAC, multiple regression analysis was conducted according to tertile groups of each macronutrient. Results: The prevalence of CAC significantly differed among tertile groups of CHO and fat intake in men (p < 0.001, p < 0.01) and women (p < 0.05, p < 0.01). However, multiple logistic regression analysis revealed that the odds ratios (ORs) for CAC were not significantly different among tertile groups of each macronutrient intake after adjustment in men (CHO: OR = 0.965 [95% CI = 0.826-1.129]; protein: OR = 1.029 [95% CI = 0.881-1.201]; fat: OR = 1.015 [95% CI = 0.868-1.188]) and women (CHO: OR = 1.158 [95% CI = 0.550-2.438]; protein: OR = 1.261 [95% CI = 0.629-2.528]; fat: OR = 0.625 [95% CI = 0.286-1.365]). Conclusions: The prevalence of CAC may not be associated with composition of dietary macronutrient intake in in healthy Korean adults. © 2014 S. Karger AG, Basel.
    Annals of Nutrition and Metabolism 12/2014; 66(1):36-43. DOI:10.1159/000369563 · 2.75 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: IntroductionAn estimated 83.6 million American adults have atherosclerotic cardiovascular vascular disease (CVD) and one in every three deaths in the Unites States is attributed to CVD. Coronary heart disease (CHD) alone caused about one of every six deaths in the US in 2008. More than half of patients who present as sudden cardiac death have no antecedent symptoms [1].Risk assessment and stratification of asymptomatic adults are essential parts of CVD preventive strategies [2]. Interventions usually have the same relative-risk reduction across different risk strata. The highest absolute-risk reduction will occur for individuals with the highest pre-treatment risk. Accordingly, determination of absolute risk is crucial to adequately assess the risk-benefit ratio.The absolute risk of a cardiovascular event can be estimated from the presence or absence of certain risk factors (RFs). Those RFs usually coexist and interact with each other. Mild elevation in multiple RFs has much more effec ...
    Current Cardiovascular Risk Reports 10/2013; 7(5):346-353. DOI:10.1007/s12170-013-0332-y


1 Download
Available from