March 28, 2021
The American Journal of Medicine
TAKE-HOME MESSAGE
- Coronary calcium scores are an independent risk factor for cardiovascular and all-cause mortality, but prior studies have not adequately looked the prognostic value of the scores for older patients or whether the prognostic value differs by gender. Utilizing data from the multicenter Coronary Artery Calcium Consortium, this study shows that coronary calcium scores and percentiles are strongly associated with cardiovascular and all-cause mortality among patients 75 years and older, and increased scores among women are particularly linked to progressively increased risk for mortality. Further analyses determined that age along with calcium scores are better clinical predictors of mortality in this population than diabetes or hypertension.
- This study confirms the utility of coronary calcium scores across age groups for cardiovascular risk stratification. Future practice guidelines should address how calcium scores can be integrated in the clinical decision–making around the initiation of statins among older patients.
ACKGROUND
Coronary calcium is a marker of coronary atherosclerosis and established predictor of cardiovascular risk in general populations; however, there are limited studies examining its prognostic value among older adults (≥75 years) and even less regarding its utility in older males compared with females. Accordingly, we sought to examine the prognostic significance of both absolute and percentile coronary calcium scores among older adults.
METHODS
The multicenter Coronary Artery Calcium Consortium consists of 66,636 asymptomatic patients without cardiovascular disease. Participants ages ≥75 were included in this study and stratified by sex. Multivariable Cox regression models were constructed to assess cardiovascular and all-cause mortality risk by Agatston coronary calcium scores and percentiles.
RESULTS
Among 2,474 asymptomatic patients (mean age 79 years, 10.4-year follow-up), prevalence of coronary artery calcium was 92%. For both sexes, but in females more so than males, higher coronary calcium score and percentiles were associated with increased cardiovascular and all-cause mortality risk. Those at the lowest coronary calcium categories (0-9 and <25 percentile) had significantly lower risk of cardiovascular and all-cause mortality relative to the rest of the population. Multivariable analyses of traditional cardiovascular risk factors and coronary artery calcium variables revealed that age and coronary calcium were the strongest independent predictors for adverse outcomes.
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