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Coronary artery calcium as a predictor of coronary heart disease, cardiovascular disease, and all-cause mortality in Asian-Americans

The Coronary Artery Calcium Consortium

Orimoloye, Olusola A.a,*; Banga, Sandeepb,*; Dardari, Zeina A.a; Uddin, S. M. Iftekhara; Budoff, Matthew J.c; Berman, Daniel S.d; Rozanski, Alane; Shaw, Leslee J.f; Rumberger, John A.g; Nasir, Khurrama,h; Miedema, Michael D.i; Blumenthal, Roger S.a; Blaha, Michael J.a; Mirbolouk, Mohammadhassana

doi: 10.1097/MCA.0000000000000746
Original research: PDF Only

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 eight CHD) were recorded, with no CVD or CHD deaths in the CAC=0 group. We noted a significantly increased risk of CHD [heart rate (HR): 2.6 (1.5–4.3)] and CVD [HR: 2.3 (1.8–2.9)] mortality per unit increase in ln (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.

aJohns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland

bDepartment of Medicine, University of Illinois College of Medicine at Peoria, Peoria, Illinois

cDepartment of Medicine, Harbor-UCLA Medical Center

dDepartment of Imaging, Cedars-Sinai Medical Center, Los Angeles, California

eDivision of Cardiology, Mount Sinai St. Luke’s Hospital

fDivision of Radiology, Weill Cornell Medical College, New York City, New York

gPrinceton Longevity Center, Princeton, New Jersey

hYale School of Medicine, New Haven, Connecticut

iMinneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA

* Olusola A. Orimoloye and Sandeep Banga contributed equally to the writing of this article.

Correspondence to Michael J. Blaha, MD, MPH, Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Blalock 525, 600 North Wolfe Street, Baltimore, MD 21287, USA Tel/fax: +1 443 287 4960; e-mail:

Received January 12, 2019

Received in revised form February 24, 2019

Accepted March 24, 2019

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