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Master of Public Health

Age-specific competing risk of cardiovascular versus cancer mortality as a function of coronary artery calcium: The Coronary Artery Calcium Consortium

AUTHORS

Whelton SP , Rifai MA , Marshall CH , Dardari Z , Shaw LJ , Al-Mallah MH , Rozanski A , Mortensen MB , Dzaye O , Bazzano L , Kelly TN , Matsushita K , Rumberger JA , Berman DS , Budoff MJ , Miedema MD , Nasir K , Blaha MJ , . The American journal of medicine. 2020 4 5; ().

ABSTRACT

BACKGROUND: Coronary artery calcium is a guideline recommended cardiovascular disease risk stratification tool that increases with age and is also associated with non-cardiovascular disease outcomes including cancer. We sought to define the age-specific change in the association between coronary artery calcium and cause-specific mortality.

METHODS: The Coronary Artery Calcium Consortium includes 59,502 asymptomatic patients age 40-75 without known cardiovascular disease. Age-stratified mortality rates and parametric survival regression modeling was performed to estimate the age-specific coronary artery calcium score at which cardiovascular disease and cancer mortality risk were equal.

RESULTS: The mean age was 54±8 years (67% men) and there were 2,423 deaths over a mean 12±3 years follow-up. Among individuals with coronary artery calcium = 0, cancer was the leading cause of death, with low cardiovascular disease mortality rates for both younger (40-54 years) 0.2/1,000 person-years and older participants (65-75 years) 1.3/1,000 person-years. When coronary artery calcium ≥400, cardiovascular disease was consistently the leading cause of death among younger (71% of deaths) and older participants (56% of deaths). The coronary artery calcium score at which cardiovascular disease overtook cancer as the leading cause of death increased exponentially with age and was approximately 115 at age 50 and 380 at age 65.

CONCLUSIONS: Regardless of age, when coronary artery calcium = 0 cancer was the leading cause of death and the cardiovascular disease mortality rate was low. Our age-specific estimate for the coronary artery calcium score at which cardiovascular disease overtakes cancer mortality allows for a more precise approach to synergistic prediction and prevention strategies for cardiovascular disease and cancer.

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