Cited by 107Cardiac Imaging and DiagnosticsHealth Promotion and Cardiovascular PreventionHealthcare Systems and Public Health

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Coronary Artery Calcium and Long-Term Risk of Death, Myocardial Infarction, and Stroke

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Mitchell, Joshua D., Paisley, Robert, Moon, Patrick, Novak, Eric, Villines, Todd C.·2018·JACC: Cardiovascular Imaging

DOI 10.1016/j.jcmg.2017.09.003

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Abstract

Objectives This study aimed to assess the long-term risk of death and atherosclerotic cardiovascular disease (ASCVD) outcomes, including stroke, in a real-world cohort that underwent coronary artery calcium (CAC) scoring. Background Large-scale, long-term studies assessing the independent relationship of CAC for prediction of ASCVD events, to include stroke, in young, low-risk patients are uncommon outside of the clinical trial setting. Methods A total of 23,637 consecutive subjects without ASCVD who underwent CAC scoring from 1997 to 2009 were studied. Subjects were assessed for myocardial infarction (MI), stroke, major adverse cardiovascular events (MACE) (e.g., MI, stroke, or cardiovascular death), and all-cause mortality. Outcomes were extracted from the Military Data Repository and the National Death Index and assessed using Cox proportional hazards models, controlling for baseline risk factors, atrial fibrillation, and competing mortality. Results Patients (mean age 50.0 ± 8.5 years) were followed over a median of 11.4 years. The relative adjusted subhazard ratio (aSHR) for CAC 1 to 100, 101 to 400, and >400 was 2.2, 3.8, and 5.9 for MI; 1.2, 1.4, and 1.9 for stroke; 1.4, 2.0, and 2.8 for MACE; and 1.2, 1.5 and 2.1 for death (p < 0.0001). The addition of CAC score to risk factors significantly improved the prognostic accuracy for all outcomes by the likelihood ratio test. Area under the curve increased from 0.658 to 0.738 for MI, 0.703 to 0.704 for stroke, 0.685 to 0.705 for MACE, and 0.759 to 0.767 for mortality. Among subjects without traditional risk factors (n = 6,208; mean age 43.8 ± 4.4 years), the presence of any CAC (>0; n = 848) was associated with an increased risk of MACE (aSHR: 1.67; 95% confidence interval: 1.16 to 2.39). Conclusions CAC scoring significantly improved long-term prognostic accuracy for MACE events and mortality, irrespective of age and risk factors. These results support CAC screening for improving individual ASCVD risk assessment and prevention in low-risk, young adults.

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Reply
Mitchell, J. D., Fergestrom, N. M., Gage, B. F., & Villines, T. C. (2019) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2019.02.017
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Additional file 1 of Evolocumab attenuate pericoronary adipose tissue density via reduction of lipoprotein(a) in type 2 diabetes mellitus: a serial follow-up CCTA study
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Authors: Mitchell, J. D., Paisley, R., Moon, P., Novak, E., & Villines, T. C.
Affiliations: Washington University in St. Louis (US)
Baylor College of Medicine (US)
Walter Reed National Military Medical Center (US)
Corresponding author: Villines, Todd C.
ORCID: Mitchell, Joshua D.
Villines, Todd C.
Venue: JACC: Cardiovascular Imaging
Publisher: Elsevier BV
Published: 2018-12
Volume: 11
Issue: 12
Pages: 1799-1806
ISSN: 1876-7591 (ISSN-L)
1936-878X
DOI: 10.1016/j.jcmg.2017.09.003
OpenAlex: W2770525978
Cited by: 107
References: 33
Citations by year: 2026: 9 · 2025: 9 · 2024: 15 · 2023: 10 · 2022: 15 · 2021: 18 · 2020: 17 · 2019: 10 · 2018: 4
FWCI: 6.31
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 365 d)
Locations: JACC. Cardiovascular imaging (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
Health Sciences › Medicine › Epidemiology › Healthcare Systems and Public Health
Keywords: coronary artery calcium, coronary artery calcium scoring, atherosclerotic cardiovascular disease, myocardial infarction, stroke, major adverse cardiovascular events, all-cause mortality, cardiovascular risk prediction, low-risk patients, young adults, prognostic accuracy, risk stratification, National Death Index, competing risk of death, atrial fibrillation
MeSH terms: Adolescent, Adult, Aged, Aged, 80 and over, Coronary Artery Disease, Female, Hospitals, Military, Humans, Male, Maryland, Middle Aged, Myocardial Infarction, Prognosis, Retrospective Studies, Risk Factors, Time Factors, Coronary Angiography, Risk Assessment, Stroke, Young Adult, Vascular Calcification

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Coronary Artery Calcium and Long-Term Risk of Death, Myocardial Infarction, and Stroke

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