Impact of coronary artery calcification on all-cause mortality in individuals with and without hypertension

Garth Graham, Michael J. Blaha, Matthew J. Budoff, Juan J. Rivera, Arthur Agatston, Paolo Raggi, Leslee J. Shaw, Daniel Berman, Jamal S. Rana, Tracy Callister, John A. Rumberger, James Min, Roger S. Blumenthal, Khurram Nasir

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Background: Coronary artery calcium (CAC) has emerged as an important prognostic indicator for coronary heart disease risk. The purpose of this study was to assess the impact of increasing CAC burden among those with and without hypertension (HTN). Methods: The study cohort consisted of 44,052 consecutive asymptomatic individuals free of known coronary heart disease referred for electron beam computed tomography (EBT) for the assessment of subclinical atherosclerosis. Patients were followed for a mean of 5.6 ± 2.6 years (range 1-13 years). The primary endpoint for the study cohort was mortality from any cause. Results: About one third (34%) of the subjects were affected by hypertension. There were 901 deaths (2.05%) in the total study population over a mean follow-up of 5.6 ± 2.6 years (range 1-13 years). The lowest event rate was observed in those with no CAC among those without hypertension (1.6 events per 1000 person years), whereas those with CAC ≥400 and hypertension had the highest all fatality rate (9.8 per 1000 person years). Compared to a CAC score of 0, increasing CAC scores (1-99, 100-399, and ≥400) were associated with increases in all-cause mortality. The hazard ratio was 2.19-7.74-fold among those without HTN and 3.00-5.83 fold among those with HTN. Overall likelihood ratio chi square statistics demonstrated that the addition of CAC scores increased mortality prediction beyond traditional risk among those with hypertension. Conclusion: Addition of CAC scores contributed significantly in predicting mortality in addition to just traditional risk factors alone among those with and without hypertension.

Original languageEnglish
Pages (from-to)432-437
Number of pages6
JournalAtherosclerosis
Volume225
Issue number2
DOIs
StatePublished - Dec 1 2012
Externally publishedYes

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Coronary Vessels
Hypertension
Calcium
Mortality
Coronary Disease
Cohort Studies
X Ray Computed Tomography
Atherosclerosis
Population

Keywords

  • Atherosclerosis
  • Coronary calcification
  • Electron beam tomography
  • Hypertension
  • Mortality
  • Risk factors

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Graham, G., Blaha, M. J., Budoff, M. J., Rivera, J. J., Agatston, A., Raggi, P., ... Nasir, K. (2012). Impact of coronary artery calcification on all-cause mortality in individuals with and without hypertension. Atherosclerosis, 225(2), 432-437. https://doi.org/10.1016/j.atherosclerosis.2012.08.014

Impact of coronary artery calcification on all-cause mortality in individuals with and without hypertension. / Graham, Garth; Blaha, Michael J.; Budoff, Matthew J.; Rivera, Juan J.; Agatston, Arthur; Raggi, Paolo; Shaw, Leslee J.; Berman, Daniel; Rana, Jamal S.; Callister, Tracy; Rumberger, John A.; Min, James; Blumenthal, Roger S.; Nasir, Khurram.

In: Atherosclerosis, Vol. 225, No. 2, 01.12.2012, p. 432-437.

Research output: Contribution to journalArticle

Graham, G, Blaha, MJ, Budoff, MJ, Rivera, JJ, Agatston, A, Raggi, P, Shaw, LJ, Berman, D, Rana, JS, Callister, T, Rumberger, JA, Min, J, Blumenthal, RS & Nasir, K 2012, 'Impact of coronary artery calcification on all-cause mortality in individuals with and without hypertension', Atherosclerosis, vol. 225, no. 2, pp. 432-437. https://doi.org/10.1016/j.atherosclerosis.2012.08.014
Graham, Garth ; Blaha, Michael J. ; Budoff, Matthew J. ; Rivera, Juan J. ; Agatston, Arthur ; Raggi, Paolo ; Shaw, Leslee J. ; Berman, Daniel ; Rana, Jamal S. ; Callister, Tracy ; Rumberger, John A. ; Min, James ; Blumenthal, Roger S. ; Nasir, Khurram. / Impact of coronary artery calcification on all-cause mortality in individuals with and without hypertension. In: Atherosclerosis. 2012 ; Vol. 225, No. 2. pp. 432-437.
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abstract = "Background: Coronary artery calcium (CAC) has emerged as an important prognostic indicator for coronary heart disease risk. The purpose of this study was to assess the impact of increasing CAC burden among those with and without hypertension (HTN). Methods: The study cohort consisted of 44,052 consecutive asymptomatic individuals free of known coronary heart disease referred for electron beam computed tomography (EBT) for the assessment of subclinical atherosclerosis. Patients were followed for a mean of 5.6 ± 2.6 years (range 1-13 years). The primary endpoint for the study cohort was mortality from any cause. Results: About one third (34{\%}) of the subjects were affected by hypertension. There were 901 deaths (2.05{\%}) in the total study population over a mean follow-up of 5.6 ± 2.6 years (range 1-13 years). The lowest event rate was observed in those with no CAC among those without hypertension (1.6 events per 1000 person years), whereas those with CAC ≥400 and hypertension had the highest all fatality rate (9.8 per 1000 person years). Compared to a CAC score of 0, increasing CAC scores (1-99, 100-399, and ≥400) were associated with increases in all-cause mortality. The hazard ratio was 2.19-7.74-fold among those without HTN and 3.00-5.83 fold among those with HTN. Overall likelihood ratio chi square statistics demonstrated that the addition of CAC scores increased mortality prediction beyond traditional risk among those with hypertension. Conclusion: Addition of CAC scores contributed significantly in predicting mortality in addition to just traditional risk factors alone among those with and without hypertension.",
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AU - Graham, Garth

AU - Blaha, Michael J.

AU - Budoff, Matthew J.

AU - Rivera, Juan J.

AU - Agatston, Arthur

AU - Raggi, Paolo

AU - Shaw, Leslee J.

AU - Berman, Daniel

AU - Rana, Jamal S.

AU - Callister, Tracy

AU - Rumberger, John A.

AU - Min, James

AU - Blumenthal, Roger S.

AU - Nasir, Khurram

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N2 - Background: Coronary artery calcium (CAC) has emerged as an important prognostic indicator for coronary heart disease risk. The purpose of this study was to assess the impact of increasing CAC burden among those with and without hypertension (HTN). Methods: The study cohort consisted of 44,052 consecutive asymptomatic individuals free of known coronary heart disease referred for electron beam computed tomography (EBT) for the assessment of subclinical atherosclerosis. Patients were followed for a mean of 5.6 ± 2.6 years (range 1-13 years). The primary endpoint for the study cohort was mortality from any cause. Results: About one third (34%) of the subjects were affected by hypertension. There were 901 deaths (2.05%) in the total study population over a mean follow-up of 5.6 ± 2.6 years (range 1-13 years). The lowest event rate was observed in those with no CAC among those without hypertension (1.6 events per 1000 person years), whereas those with CAC ≥400 and hypertension had the highest all fatality rate (9.8 per 1000 person years). Compared to a CAC score of 0, increasing CAC scores (1-99, 100-399, and ≥400) were associated with increases in all-cause mortality. The hazard ratio was 2.19-7.74-fold among those without HTN and 3.00-5.83 fold among those with HTN. Overall likelihood ratio chi square statistics demonstrated that the addition of CAC scores increased mortality prediction beyond traditional risk among those with hypertension. Conclusion: Addition of CAC scores contributed significantly in predicting mortality in addition to just traditional risk factors alone among those with and without hypertension.

AB - Background: Coronary artery calcium (CAC) has emerged as an important prognostic indicator for coronary heart disease risk. The purpose of this study was to assess the impact of increasing CAC burden among those with and without hypertension (HTN). Methods: The study cohort consisted of 44,052 consecutive asymptomatic individuals free of known coronary heart disease referred for electron beam computed tomography (EBT) for the assessment of subclinical atherosclerosis. Patients were followed for a mean of 5.6 ± 2.6 years (range 1-13 years). The primary endpoint for the study cohort was mortality from any cause. Results: About one third (34%) of the subjects were affected by hypertension. There were 901 deaths (2.05%) in the total study population over a mean follow-up of 5.6 ± 2.6 years (range 1-13 years). The lowest event rate was observed in those with no CAC among those without hypertension (1.6 events per 1000 person years), whereas those with CAC ≥400 and hypertension had the highest all fatality rate (9.8 per 1000 person years). Compared to a CAC score of 0, increasing CAC scores (1-99, 100-399, and ≥400) were associated with increases in all-cause mortality. The hazard ratio was 2.19-7.74-fold among those without HTN and 3.00-5.83 fold among those with HTN. Overall likelihood ratio chi square statistics demonstrated that the addition of CAC scores increased mortality prediction beyond traditional risk among those with hypertension. Conclusion: Addition of CAC scores contributed significantly in predicting mortality in addition to just traditional risk factors alone among those with and without hypertension.

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KW - Electron beam tomography

KW - Hypertension

KW - Mortality

KW - Risk factors

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