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: 16.5). 07/2008; 52(1):17-23. DOI: 10.1016/j.jacc.2008.04.004
Source: PubMed


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.

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    • "In another study comprising 35,388 asymptomatic patients, hazard ratio for death was found highly dependent on calcium score and age. In the age group 60–69 years (3,519 women and 3,926 men, age comparable to our study group), hazard ratio increased from 2.1 to 5.1 for scores above 10 (Raggi et al. 2008). These studies demonstrate the clinical relevance of very low calcium scores in relationship with survival. "
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    ABSTRACT: Offspring of long-lived parents have a low prevalence of cardiovascular disease in middle age. The purposes of this study were to investigate calcium scores in offspring as compared to controls and to determine the influence of cardiovascular risk factors. CT coronary artery calcium score was measured in offspring of long-lived families (n = 244, 125 males) and their partners (n = 223, 96 males) who served as controls. Calcium scores were analyzed separately for sexes. Subjects were grouped by very low calcium score ≤10 and scores above 10. Nonparametric Mann-Whitney test, chi-squared tests, and logistic regression analyses were performed to determine the association between calcium scores, familial longevity, and cardiovascular risk factors. More offspring of long-lived parents had lower calcium scores than controls. In men, 34 % of offspring had score ≤10 versus 21 % of controls (odds ratio (OR) and 95 % confidence interval (CI) 2.0, 1.08-3.7, p = 0.028). In women, 70 % of offspring had score ≤10 versus 54 % of controls (OR 1.9, 95 % CI 1.13-3.4, p = 0.019). Differences remained significant after correction for age (men, p = 0.043 and women, p = 0.003) and further correction for major risk factors in women, indicating genetic influence for lower calcium scores. In men, the association was found to be influenced by cardiovascular risk factors. Men and women with a familial propensity to become long-lived have lower coronary artery calcium scores than controls. Low scores may indicate a younger biologic arterial age associated with a low risk for incident cardiovascular disease.
    Preview · Article · Aug 2014 · Journal of the American Aging Association
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    • "Coronary artery calcium is a marker of coronary atherosclerosis, and the quantity of coronary artery calcification is correlated with the coronary atherosclerotic plaque burden. Numerous studies have demonstrated that the coronary artery calcium score is associated with the risk of future cardiovascular events (1-5), and the detection of coronary artery calcification with cardiac CT has been extensively used for risk stratification. In a recent study from Multi-Ethnic Study of Atherosclerosis (MESA) (4), in a population-based cohort of individuals without known cardiovascular disease, 6722 subjects were followed for a median follow-up period of 3.8 years. "
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    ABSTRACT: Cardiac computed tomography (CT) has emerged as a noninvasive modality for the assessment of coronary artery disease (CAD), and has been rapidly integrated into clinical cares. CT has changed the traditional risk stratification based on clinical risk to image-based identification of patient risk. Cardiac CT, including coronary artery calcium score and coronary CT angiography, can provide prognostic information and is expected to improve risk stratification of CAD. Currently used conventional cardiac CT, provides accurate anatomic information but not functional significance of CAD, and it may not be sufficient to guide treatments such as revascularization. Recently, myocardial CT perfusion imaging, intracoronary luminal attenuation gradient, and CT-derived computed fractional flow reserve were developed to combine anatomical and functional data. Although at present, the diagnostic and prognostic value of these novel technologies needs to be evaluated further, it is expected that all-in-one cardiac CT can guide treatment and improve patient outcomes in the near future.
    Full-text · Article · Jan 2014 · Korean journal of radiology: official journal of the Korean Radiological Society
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    • "The prevalence of VC in our study was 70.0%, and although there were some differences from previous studies because of the different evaluation methods used, the finding of a high prevalence of VC in hemodialysis patients was consistent with most studies [8,15,16]. Our study showed an increased risk of all-cause and cardiovascular mortality with higher VC scores, which was consistent with most previous studies [15,17-19]. Our results showed a positive correlation between all-cause mortality and abdominal aortic VC, after adjustment for different VC combinations. "
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    ABSTRACT: Background KDIGO (Kidney Disease: Improving Global Outcomes) guidelines recommend that a lateral abdominal radiograph should be performed to assess vascular calcification (VC) in dialysis patients. However, abdominal aortic calcification is a prevalent finding, and it remains unclear whether other anatomical areas of VC can predict mortality more accurately. Methods A total of 217 maintenance hemodialysis patients were enrolled at the Sichuan Provincial People’s Hospital between July 2010 and March 2011. Radiographs of the abdomen, pelvis and hands were evaluated by a radiologist to evaluate the presence of VC. The correlation between different areas of VC and all-cause or cardiovascular mortality was analyzed using univariate and multivariate models. Results The prevalence of VC was 70.0% (152 patients), and most had abdominal aortic calcification (90.1%). During 26 ± 7 months of follow-up, 37 patients died. The VC score was independently associated with patient mortality. VC observed on abdominal radiographs (abdominal aortic calcification) was associated with all-cause mortality in models adjusted for cardiovascular risk factors (HR, 4.69; 95%CI, 1.60-13.69) and dialysis factors (HR, 3.38; 95%CI, 1.18-9.69). VC in the pelvis or hands was associated with all-cause mortality in the model adjusted for dialysis factors. When three combinations of VC in different radiographs were included in models, the presence of abdominal VC was only significantly associated with all-cause mortality in the integrated model. VC in the abdomen and pelvis was associated with all-cause mortality in the model adjusted for cardiovascular factors and the integrated model, but neither was significantly associated with cardiovascular mortality. VC in all radiographs was significantly associated with a more than 6-fold risk of all-cause mortality and a more than 5-fold risk of cardiovascular mortality compared to patients without VC. Conclusions VC in different arteries as shown on radiographs is associated with different levels of risk for mortality. The lateral abdominal radiograph may not be superior to other radiographs for predicting patient outcomes. Further research is needed to elucidate the effects of difference burdens of VC on patient outcomes.
    Full-text · Article · Jun 2013 · BMC Nephrology
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