Leslee J. Shaw, PhD; Ashley E. Giambrone, PhD; Michael J. Blaha, MD; Joseph T. Knapper, MD; Daniel S. Berman, MD; Naveen Bellam, MD; Arshed Quyyumi, MD; Matthew J. Budoff, MD; Tracy Q. Callister, MD; James K. Min, MD
Disclosures: Dr. Blaha reports grants from the U.S. Food and Drug Administration/National Institutes of Health, American Heart Association, and Aetna and personal fees from Pfizer and Luitpold Pharmaceuticals outside the submitted work. Dr. Budoff reports grants from General Electric Healthcare during the conduct of the study. Dr. Min reports grants from the National Heart, Lung, and Blood Institute and National Research Foundation of Korea and other from Michael Wolk Heart Foundation and General Electric Healthcare during the conduct of the study, as well as other from Vital Images, Philips Healthcare, Arineta, AstraZeneca, Bristol-Myers Squibb, and HeartFlow outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/Conflict
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer.
Reproducible Research Statement:Study protocol and data set: Not available. Statistical code: Available from Dr. Shaw (e-mail, firstname.lastname@example.org).
Requests for Single Reprints: Leslee J. Shaw, PhD, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, 1462 Clifton Road Northeast, Room 529, Atlanta, GA 30322; e-mail, email@example.com.
Current Author Addresses: Dr. Shaw: Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, 1462 Clifton Road Northeast, Room 529, Atlanta, GA 30322.
Dr. Giambrone: Department of Public Health, Division of Biostatistics and Epidemiology, Weill Cornell Medical College, 402 East 67th Street, New York, NY 10065.
Dr. Blaha: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Carnegie 565A, 600 North Wolfe Street, Baltimore, MD 21287.
Dr. Knapper: Emory University School of Medicine, 116 Ponce de Leon Avenue Northeast, 2314, Atlanta, GA 30308.
Dr. Berman: Cedars-Sinai Medical Center, 8700 Beverly Boulevard, 1258 Taper Building, Los Angeles, CA 90048-0750.
Dr. Bellam: Thomas Jefferson University, 925 Chestnut Street, Philadelphia, PA 19147.
Dr. Quyyumi: Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, 1462 Clifton Road Northeast, Suite 507, Atlanta, GA 30322.
Dr. Budoff: Los Angeles Biomedical Research Institute, 1124 West Carson Street, Torrance, CA 90502.
Dr. Callister: Tennessee Heart and Vascular Institute, 353 New Shackle Island Road, Hendersonville, TN 37075.
Dr. Min: Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College, 525 East 68th Street, New York, NY 10065.
Author Contributions: Conception and design: L.J. Shaw, D.S. Berman, A. Quyyumi, M.J. Budoff, T.Q. Callister, J.K. Min.
Analysis and interpretation of the data: L.J. Shaw, A.E. Giambrone, M.J. Blaha, N. Bellam, M.J. Budoff, T.Q. Callister.
Drafting of the article: L.J. Shaw, N. Bellam, J.K. Min.
Critical revision of the article for important intellectual content: L.J. Shaw, M.J. Blaha, J.T. Knapper, D.S. Berman, A. Quyyumi, M.J. Budoff, T.Q. Callister, J.K. Min.
Final approval of the article: L.J. Shaw, M.J. Blaha, J.T. Knapper, D.S. Berman, A. Quyyumi, M.J. Budoff, T.Q. Callister, J.K. Min.
Provision of study materials or patients: T.Q. Callister, J.K. Min.
Statistical expertise: L.J. Shaw, A.E. Giambrone, M.J. Blaha, J.K. Min.
Obtaining of funding: J.K. Min.
Administrative, technical, or logistic support: L.J. Shaw, T.Q. Callister, J.K. Min.
Collection and assembly of data: M.J. Budoff, T.Q. Callister, J.K. Min.
The extent of coronary artery calcification (CAC) and near-term adverse clinical outcomes are strongly related through 5 years of follow-up.
To describe the ability of CAC scores to predict long-term mortality in persons without symptoms of coronary artery disease.
Single-center, outpatient cardiology laboratory.
9715 asymptomatic patients.
Coronary artery calcification scoring and binary risk factor data were collected. The primary end point was time to all-cause mortality (median follow-up, 14.6 years). Univariable and multivariable Cox proportional hazards models were used to compare survival distributions. The net reclassification improvement statistic was calculated.
In Cox models adjusted for risk factors for coronary artery disease, the CAC score was highly predictive of all-cause mortality (P < 0.001). Overall 15-year mortality rates ranged from 3% to 28% for CAC scores from 0 to 1000 or greater (P < 0.001). The relative hazard for all-cause mortality ranged from 1.68 for a CAC score of 1 to 10 (P < 0.001) to 6.26 for a score of 1000 or greater (P < 0.001). The categorical net reclassification improvement using cut points of less than 7.5% to 22.5% or greater was 0.21 (95% CI, 0.16 to 0.32).
Data collection was limited to a single center with generalizability limitations. Only binary risk factor data were available, and CAC was only measured once.
The extent of CAC accurately predicts 15-year mortality in a large cohort of asymptomatic patients. Long-term estimates of mortality provide a unique opportunity to examine the value of novel biomarkers, such as CAC, in estimating important patient outcomes.
Shaw LJ, Giambrone AE, Blaha MJ, Knapper JT, Berman DS, Bellam N, et al. Long-Term Prognosis After Coronary Artery Calcification Testing in Asymptomatic Patients: A Cohort Study. Ann Intern Med. ;163:14–21. doi: 10.7326/M14-0612
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Published: Ann Intern Med. 2015;163(1):14-21.
Cardiology, Coronary Heart Disease, Coronary Risk Factors.
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