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Patients whose coronary artery calcium scores exceeded 400 were significantly more likely to develop cancer, chronic obstructive pulmonary disease, chronic kidney disease, and hip fractures, compared with adults with undetectable CAC, in an analysis of the Multi-Ethnic Study of Atherosclerosis reported March 9 in JACC Cardiovascular Imaging.
The study is the first to examine the relationship between CAC and significant noncardiovascular diseases, said Dr. Catherine Handy of the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore. Patients with CAC scores of zero represent a unique group of “healthy agers,” she and her associates said. Conversely, 20% of initial non-CVD events occurred in the 10% of patients with CAC scores over 400, and 70% of events occurred in patients with scores greater than zero, they reported.
While CAC is an established indicator of vascular aging, CVD risk, and all-cause mortality, its relationship with non-CVD is unclear. To elucidate the issue, the researchers analyzed data from the prospective, observational Multi-Ethnic Study of Atherosclerosis, which included 6,814 adults aged 45-84 years from six U.S. cities. Patients had no CVD and were not receiving cancer treatment.
Over a median follow-up period of 10.2 years, and after controlling for demographic factors and predictors of CVD, patients with CAC scores exceeding 400 were significantly more likely to develop cancer (hazard ratio, 1.53), chronic kidney disease (HR, 1.70), pneumonia (HR, 1.97), chronic obstructive pulmonary disease (HR, 2.71) and hip fracture (HR, 4.29), compared with patients without detectable CAC. Patients with CAC scores of zero were at significantly lower risk of these diagnoses, compared with patients with scores greater than zero (JACC Cardiovasc Imaging. 2016 Mar 9. doi: 10.1016/j.jcmg.2015.09.02).
Doubling of CAC was a modest but significant predictor of cancer, chronic kidney disease, pneumonia, and chronic obstructive pulmonary disease in the subgroup of adults aged 65 years and older. However, CAC was not associated with dementia or deep vein thrombosis or pulmonary embolism.
Sparse diagnoses of hip fractures and DVT/PE meant that the study might be underpowered to clearly link CAC with risk of these events, said the researchers. There also might not have been enough follow-up time to uncover risk in participants with the lowest CAC scores, they said. “At this time, our data are not powered for stratifying results based on gender or race,” they added.
The National Institutes of Health funded the study. The researchers had no conflicts of interest.
The current report from the Multi-Ethnic Study of Atherosclerosis further expands the evidence base supporting the concept of coronary artery calcium as a marker of global health by examining its prognostic power across a diversity of noncardiovascular conditions.
Regardless of the directionality or magnitude of the connections between cardiovascular disease and non-CVD conditions, the extent to which coronary artery calcium–guided patient adherence to risk factor modification and lifestyle recommendations [affected] non-CVD conditions remains an additional link that should be explored further.
A synthesis of evidence, including the study by Handy et al., now supports the predictive ability of coronary artery calcium to estimate cardiac, cerebrovascular, and noncardiovascular conditions. We likely should come full circle in our discussion and acknowledge the far reaching implications of its predictive ability. Perhaps our index response that CAC should be fully integrated into all adult wellness and screening evaluations was on target after all!
Although CAC has not been without its critics and is not supported as a reimbursable procedure, its expansive evidence warrants a more thoughtful discussion within the CVD community that this powerful procedure provides valuable information to guide health care decision making.
Dr. Mosaab Awad, Dr. Parham Eshtehardi, and Leslee J. Shaw, Ph.D., of Emory University Clinical Cardiovascular Research Institute, Emory University, Atlanta, made these comments in an editorial (JACC Cardiovasc Imaging. 2016 Mar 9. doi: 10.1016/j.jcmg.2015.09.021). They had no disclosures.
The current report from the Multi-Ethnic Study of Atherosclerosis further expands the evidence base supporting the concept of coronary artery calcium as a marker of global health by examining its prognostic power across a diversity of noncardiovascular conditions.
Regardless of the directionality or magnitude of the connections between cardiovascular disease and non-CVD conditions, the extent to which coronary artery calcium–guided patient adherence to risk factor modification and lifestyle recommendations [affected] non-CVD conditions remains an additional link that should be explored further.
A synthesis of evidence, including the study by Handy et al., now supports the predictive ability of coronary artery calcium to estimate cardiac, cerebrovascular, and noncardiovascular conditions. We likely should come full circle in our discussion and acknowledge the far reaching implications of its predictive ability. Perhaps our index response that CAC should be fully integrated into all adult wellness and screening evaluations was on target after all!
Although CAC has not been without its critics and is not supported as a reimbursable procedure, its expansive evidence warrants a more thoughtful discussion within the CVD community that this powerful procedure provides valuable information to guide health care decision making.
Dr. Mosaab Awad, Dr. Parham Eshtehardi, and Leslee J. Shaw, Ph.D., of Emory University Clinical Cardiovascular Research Institute, Emory University, Atlanta, made these comments in an editorial (JACC Cardiovasc Imaging. 2016 Mar 9. doi: 10.1016/j.jcmg.2015.09.021). They had no disclosures.
The current report from the Multi-Ethnic Study of Atherosclerosis further expands the evidence base supporting the concept of coronary artery calcium as a marker of global health by examining its prognostic power across a diversity of noncardiovascular conditions.
Regardless of the directionality or magnitude of the connections between cardiovascular disease and non-CVD conditions, the extent to which coronary artery calcium–guided patient adherence to risk factor modification and lifestyle recommendations [affected] non-CVD conditions remains an additional link that should be explored further.
A synthesis of evidence, including the study by Handy et al., now supports the predictive ability of coronary artery calcium to estimate cardiac, cerebrovascular, and noncardiovascular conditions. We likely should come full circle in our discussion and acknowledge the far reaching implications of its predictive ability. Perhaps our index response that CAC should be fully integrated into all adult wellness and screening evaluations was on target after all!
Although CAC has not been without its critics and is not supported as a reimbursable procedure, its expansive evidence warrants a more thoughtful discussion within the CVD community that this powerful procedure provides valuable information to guide health care decision making.
Dr. Mosaab Awad, Dr. Parham Eshtehardi, and Leslee J. Shaw, Ph.D., of Emory University Clinical Cardiovascular Research Institute, Emory University, Atlanta, made these comments in an editorial (JACC Cardiovasc Imaging. 2016 Mar 9. doi: 10.1016/j.jcmg.2015.09.021). They had no disclosures.
Patients whose coronary artery calcium scores exceeded 400 were significantly more likely to develop cancer, chronic obstructive pulmonary disease, chronic kidney disease, and hip fractures, compared with adults with undetectable CAC, in an analysis of the Multi-Ethnic Study of Atherosclerosis reported March 9 in JACC Cardiovascular Imaging.
The study is the first to examine the relationship between CAC and significant noncardiovascular diseases, said Dr. Catherine Handy of the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore. Patients with CAC scores of zero represent a unique group of “healthy agers,” she and her associates said. Conversely, 20% of initial non-CVD events occurred in the 10% of patients with CAC scores over 400, and 70% of events occurred in patients with scores greater than zero, they reported.
While CAC is an established indicator of vascular aging, CVD risk, and all-cause mortality, its relationship with non-CVD is unclear. To elucidate the issue, the researchers analyzed data from the prospective, observational Multi-Ethnic Study of Atherosclerosis, which included 6,814 adults aged 45-84 years from six U.S. cities. Patients had no CVD and were not receiving cancer treatment.
Over a median follow-up period of 10.2 years, and after controlling for demographic factors and predictors of CVD, patients with CAC scores exceeding 400 were significantly more likely to develop cancer (hazard ratio, 1.53), chronic kidney disease (HR, 1.70), pneumonia (HR, 1.97), chronic obstructive pulmonary disease (HR, 2.71) and hip fracture (HR, 4.29), compared with patients without detectable CAC. Patients with CAC scores of zero were at significantly lower risk of these diagnoses, compared with patients with scores greater than zero (JACC Cardiovasc Imaging. 2016 Mar 9. doi: 10.1016/j.jcmg.2015.09.02).
Doubling of CAC was a modest but significant predictor of cancer, chronic kidney disease, pneumonia, and chronic obstructive pulmonary disease in the subgroup of adults aged 65 years and older. However, CAC was not associated with dementia or deep vein thrombosis or pulmonary embolism.
Sparse diagnoses of hip fractures and DVT/PE meant that the study might be underpowered to clearly link CAC with risk of these events, said the researchers. There also might not have been enough follow-up time to uncover risk in participants with the lowest CAC scores, they said. “At this time, our data are not powered for stratifying results based on gender or race,” they added.
The National Institutes of Health funded the study. The researchers had no conflicts of interest.
Patients whose coronary artery calcium scores exceeded 400 were significantly more likely to develop cancer, chronic obstructive pulmonary disease, chronic kidney disease, and hip fractures, compared with adults with undetectable CAC, in an analysis of the Multi-Ethnic Study of Atherosclerosis reported March 9 in JACC Cardiovascular Imaging.
The study is the first to examine the relationship between CAC and significant noncardiovascular diseases, said Dr. Catherine Handy of the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore. Patients with CAC scores of zero represent a unique group of “healthy agers,” she and her associates said. Conversely, 20% of initial non-CVD events occurred in the 10% of patients with CAC scores over 400, and 70% of events occurred in patients with scores greater than zero, they reported.
While CAC is an established indicator of vascular aging, CVD risk, and all-cause mortality, its relationship with non-CVD is unclear. To elucidate the issue, the researchers analyzed data from the prospective, observational Multi-Ethnic Study of Atherosclerosis, which included 6,814 adults aged 45-84 years from six U.S. cities. Patients had no CVD and were not receiving cancer treatment.
Over a median follow-up period of 10.2 years, and after controlling for demographic factors and predictors of CVD, patients with CAC scores exceeding 400 were significantly more likely to develop cancer (hazard ratio, 1.53), chronic kidney disease (HR, 1.70), pneumonia (HR, 1.97), chronic obstructive pulmonary disease (HR, 2.71) and hip fracture (HR, 4.29), compared with patients without detectable CAC. Patients with CAC scores of zero were at significantly lower risk of these diagnoses, compared with patients with scores greater than zero (JACC Cardiovasc Imaging. 2016 Mar 9. doi: 10.1016/j.jcmg.2015.09.02).
Doubling of CAC was a modest but significant predictor of cancer, chronic kidney disease, pneumonia, and chronic obstructive pulmonary disease in the subgroup of adults aged 65 years and older. However, CAC was not associated with dementia or deep vein thrombosis or pulmonary embolism.
Sparse diagnoses of hip fractures and DVT/PE meant that the study might be underpowered to clearly link CAC with risk of these events, said the researchers. There also might not have been enough follow-up time to uncover risk in participants with the lowest CAC scores, they said. “At this time, our data are not powered for stratifying results based on gender or race,” they added.
The National Institutes of Health funded the study. The researchers had no conflicts of interest.
FROM JACC CARDIOVASCULAR IMAGING