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Coron Artery Dis. 2019 Dec;30(8):608-614. doi: 10.1097/MCA.0000000000000746.

Coronary artery calcium as a predictor of coronary heart disease, cardiovascular disease, and all-cause mortality in Asian-Americans: The Coronary Artery Calcium Consortium.

Author information

1
Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland.
2
Department of Medicine, University of Illinois College of Medicine at Peoria, Peoria, Illinois.
3
Department of Medicine, Harbor-UCLA Medical Center.
4
Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California.
5
Division of Cardiology, Mount Sinai St. Luke's Hospital.
6
Division of Radiology, Weill Cornell Medical College, New York City, New York.
7
Princeton Longevity Center, Princeton, New Jersey.
8
Yale School of Medicine, New Haven, Connecticut.
9
Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA.

Abstract

BACKGROUND:

Coronary artery calcium (CAC) has been shown in multiple populations to predict atherosclerotic cardiovascular disease. However, its predictive value in Asian-Americans is poorly described.

PATIENTS AND METHODS:

We studied 1621 asymptomatic Asian-Americans in the CAC Consortium, a large multicenter retrospective cohort. CAC was modeled in categorical (CAC = 0; CAC = 1-99; CAC = 100-399; CAC ≥ 400) and continuous [ln (CAC + 1)] forms. Participants were followed over a mean follow-up of 12 ± 4 years for coronary heart disease (CHD) death, cardiovascular disease (CVD) death, and all-cause mortality. The predictive value of CAC for individual outcomes was assessed using multivariable-adjusted Cox regression models adjusted for traditional cardiovascular risk factors and reported as hazard ratios (95% confidence interval).

RESULTS:

The mean (SD) age of the population was 54 (11.2) years and 64% were men. The mean 10-year atherosclerotic cardiovascular disease risk score was 8%. Approximately half had a CAC score of 0, whereas 22.5% had a CAC score of greater than 100. A total of 56 deaths (16 CVD and 8 CHD) were recorded, with no CVD or CHD deaths in the CAC = 0 group. We noted a significantly increased risk of CHD [hazard ratio (HR): 2.6 (1.5-4.3)] and CVD [HR: 2.3 (1.8-2.9)] mortality per unit increase in In (CAC + 1). Compared to those with CAC scores of 0, individuals with CAC scores of at least 400 had over a three-fold increased risk of all-cause mortality [HR: 3.3 (1.3-8.6)].

CONCLUSION:

Although Asian-Americans are a relatively low-risk group, CAC strongly predicts CHD, CVD, and all-cause mortality beyond traditional risk factors. These findings may help address existing knowledge gaps in CVD risk prediction in Asian-Americans.

PMID:
31486775
PMCID:
PMC6825877
[Available on 2020-12-01]
DOI:
10.1097/MCA.0000000000000746

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