• Seamus P Whelton, RifaiMahmoud AlMAJohns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Md., MarshallCatherine HandyCHJohns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Md; Sidney Kimmel Comprehensive Cancer Center, Baltimore, Md., Zeina Dardari, Leslee J Shaw, Mouaz H Al-Mallah, Alan Rozanski, Martin B Mortensen, Omar Dzaye, Lydia Bazzano, Tanika N Kelly, Kunihiro Matsushita, John A Rumberger, Daniel S Berman, Matthew J Budoff, Michael D Miedema, Khurram Nasir, and Michael J Blaha.
• Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Md. Electronic address: seamus.whelton@jhmi.edu.
• Am. J. Med. 2020 Oct 1; 133 (10): e575-e583.

BackgroundCoronary artery calcium (CAC) is a guideline recommended cardiovascular disease (CVD) risk stratification tool that increases with age and is associated with non-cardiovascular disease outcomes including cancer. We sought to define the age-specific change in the association between CAC and cause-specific mortality.MethodsThe Coronary Artery Calcium Consortium includes 59,502 asymptomatic patients age 40-75 without known CVD. Age-stratified mortality rates and parametric survival regression modeling was performed to estimate the age-specific CAC score at which CVD and cancer mortality risk were equal.ResultsThe 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 CAC = 0, cancer was the leading cause of death, with low CVD 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 CAC ≥400, CVD was consistently the leading cause of death among younger (71% of deaths) and older participants (56% of deaths). The CAC score at which CVD overtook cancer as the leading cause of death increased exponentially with age and was approximately 115 at age 50 and 380 at age 65.ConclusionsRegardless of age, when CAC = 0 cancer was the leading cause of death and the cardiovascular disease mortality rate was low. Our age-specific estimate for the CAC score at which CVD overtakes cancer mortality allows for a more precise approach to synergistic prediction and prevention strategies for CVD and cancer.Copyright © 2020 Elsevier Inc. All rights reserved.

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