Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Md.
Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Md.
Am J Med. 2020 Oct;133(10):e575-e583. doi: 10.1016/j.amjmed.2020.02.034. Epub 2020 Apr 5.
Coronary 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.
The 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.
The 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.
Regardless 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.
冠状动脉钙（CAC）是一种指南推荐的心血管疾病（CVD）风险分层工具，其随年龄增长而增加，并与非心血管疾病结局相关，包括癌症。我们旨在确定 CAC 与特定原因死亡率之间关联的年龄特异性变化。
冠状动脉钙联合会包括 59502 名无症状、年龄在 40-75 岁之间且无已知 CVD 的患者。按年龄分层死亡率和参数生存回归模型用于估计 CAC 评分的年龄特异性切点，该切点时 CVD 和癌症死亡率相等。
平均年龄为 54±8 岁（67%为男性），平均随访 12±3 年后有 2423 人死亡。在 CAC=0 的个体中，癌症是主要死因，年轻（40-54 岁）和较年长（65-75 岁）参与者的 CVD 死亡率均较低，分别为 0.2/1000 人年和 1.3/1000 人年。当 CAC≥400 时，CVD 一直是年轻（71%的死亡）和较年长（56%的死亡）参与者的主要死因。CAC 评分作为主要死因超过癌症的切点随年龄呈指数增长，在 50 岁时约为 115，在 65 岁时约为 380。
无论年龄大小，当 CAC=0 时癌症是主要死因，CVD 死亡率较低。我们对 CAC 评分的年龄特异性估计切点，该切点时 CVD 超过癌症死亡率，可更精确地采用协同预测和预防 CVD 和癌症的策略。
