A 15-year warranty period for asymptomatic individuals without coronary artery calcium: A prospective follow-up of 9,715 individuals

Valentina Valenti; Bríain Ó Hartaigh; Ran Heo; Iksung Cho; Joshua Schulman-Marcus; Heidi Gransar; Quynh A. Truong; Leslee J. Shaw; Joseph Knapper; Anita A. Kelkar; Pratik Sandesara; Fay Y. Lin; Sebastiano Sciarretta; Hyuk Jae Chang; Tracy Q. Callister; James K. Min

doi:10.1016/j.jcmg.2015.01.025

A 15-year warranty period for asymptomatic individuals without coronary artery calcium: A prospective follow-up of 9,715 individuals

Valentina Valenti, Bríain Ó Hartaigh, Ran Heo, Iksung Cho, Joshua Schulman-Marcus, Heidi Gransar, Quynh A. Truong, Leslee J. Shaw, Joseph Knapper, Anita A. Kelkar, Pratik Sandesara, Fay Y. Lin, Sebastiano Sciarretta, Hyuk Jae Chang, Tracy Q. Callister, James K. Min

Medicine - Cardiology Division

Research output: Contribution to journal › Article › peer-review

190 Scopus citations

Abstract

Objectives The aim of this study was to examine the long-term prognosis in asymptomatic individuals with a coronary artery calcium (CAC) score of 0 and its associated warranty period. Background Emerging evidence supports a CAC score of 0 as a favorable cardiovascular short-to intermediate-term prognostic factor. Methods A total of 9,715 individuals undergoing CAC imaging were stratified by age, Framingham risk score (FRS), and National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) categories and followed for a mean of 14.6 years (range 12.9 to 16.8 years). Cox regression, area under the receiver-operating characteristic curve, and net reclassification information were used to assess all-cause mortality, discrimination, and reclassification of a CAC score of 0 compared with the FRS and NCEP ATP III, respectively. A warranty period was pre-defined as <1% annual mortality rate. Vascular age was estimated by linear regression. Results In 4,864 individuals with a baseline CAC score of 0 (mean age, 52.1 ± 10.8 years; 57.9% male), 229 deaths occurred. The warranty period of a CAC score of 0 was almost 15 years for individuals at low and intermediate risk with no significant differences regarding age and sex. A CAC score of 0 was associated with a vascular age of 1, 10, 20, and 30 years less than the chronological age of individuals between 50 and 59, 60 and 69, 70 and 79, and 80 years of age and older, respectively. The CAC score was the strongest predictor of death (hazard ratio: 2.67, 95% confidence interval: 2.29 to 3.11) that enabled discrimination and consistent reclassification beyond the FRS (area under the receiver-operating characteristic curve: 0.71 vs. 0.64, p < 0.001) and NCEP ATP III (area under the receiver-operating characteristic curve: 0.72 vs. 0.64, p < 0.001). Conclusions A CAC score of 0 confers a 15-year warranty period against mortality in individuals at low to intermediate risk that is unaffected by age or sex. Furthermore, in individuals considered at high risk by clinical risk scores, a CAC score of 0 confers better survival than in individuals at low to intermediate risk but with any CAC score.

Original language	English (US)
Pages (from-to)	900-909
Number of pages	10
Journal	JACC: Cardiovascular Imaging
Volume	8
Issue number	8
DOIs	https://doi.org/10.1016/j.jcmg.2015.01.025
State	Published - Aug 1 2015

Bibliographical note

Funding Information:
This study was supported in part by grants from the National Institutes of Health (R01HL115150 and R01HL118019) and also funded in part by a generous gift from the Dalio Institute of Cardiovascular Imaging and the Michael Wolk Foundation. Dr. Truong is supported by NIH grants K23HL098370 and L30HL093896 and has received grant support from St. Jude Medical, American College of Radiology Imaging Network, and Duke Clinical Research Institute. Dr. Chang is supported by Leading Foreign Research Institute Recruitment Program through the National Research Foundation of Korea funded by the Ministry of Science, ICT, & Future Planning (MSIP) grant 2012027176. Dr. Min has served on the medical advisory boards of GE Healthcare, Arineta, AstraZeneca, and Bristol-Myers Squibb; on the Speakers Bureau of GE Healthcare; received research support from GE Healthcare, Vital Images, and Phillips Healthcare; serves as a consultant to AstraZeneca, Abbott Vascular, HeartFlow, NeoGraft Technologies, MyoKardia, and CardioDx; and is supported by grants NIH/NHLBI-R01 HL111141, NIH/NHLBI-R01 HL115150, NIH/NHLBI-R01 HL118019, NIH/NHLBI-U01 HL105907, and a grant from the Qatar National Research Foundation NPRP09-370-3-089. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Sherif Nagueh, MD, served as Guest Editor for this paper.

Publisher Copyright:
© 2015 American College of Cardiology Foundation.

Keywords

computed tomography
coronary artery calcium
mortality
prognosis
warranty period

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Valenti, V., Ó Hartaigh, B., Heo, R., Cho, I., Schulman-Marcus, J., Gransar, H., Truong, Q. A., Shaw, L. J., Knapper, J., Kelkar, A. A., Sandesara, P., Lin, F. Y., Sciarretta, S., Chang, H. J., Callister, T. Q., & Min, J. K. (2015). A 15-year warranty period for asymptomatic individuals without coronary artery calcium: A prospective follow-up of 9,715 individuals. JACC: Cardiovascular Imaging, 8(8), 900-909. https://doi.org/10.1016/j.jcmg.2015.01.025

Valenti, V, Ó Hartaigh, B, Heo, R, Cho, I, Schulman-Marcus, J, Gransar, H, Truong, QA, Shaw, LJ, Knapper, J, Kelkar, AA, Sandesara, P, Lin, FY, Sciarretta, S, Chang, HJ, Callister, TQ & Min, JK 2015, 'A 15-year warranty period for asymptomatic individuals without coronary artery calcium: A prospective follow-up of 9,715 individuals', JACC: Cardiovascular Imaging, vol. 8, no. 8, pp. 900-909. https://doi.org/10.1016/j.jcmg.2015.01.025

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title = "A 15-year warranty period for asymptomatic individuals without coronary artery calcium: A prospective follow-up of 9,715 individuals",

abstract = "Objectives The aim of this study was to examine the long-term prognosis in asymptomatic individuals with a coronary artery calcium (CAC) score of 0 and its associated warranty period. Background Emerging evidence supports a CAC score of 0 as a favorable cardiovascular short-to intermediate-term prognostic factor. Methods A total of 9,715 individuals undergoing CAC imaging were stratified by age, Framingham risk score (FRS), and National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) categories and followed for a mean of 14.6 years (range 12.9 to 16.8 years). Cox regression, area under the receiver-operating characteristic curve, and net reclassification information were used to assess all-cause mortality, discrimination, and reclassification of a CAC score of 0 compared with the FRS and NCEP ATP III, respectively. A warranty period was pre-defined as <1% annual mortality rate. Vascular age was estimated by linear regression. Results In 4,864 individuals with a baseline CAC score of 0 (mean age, 52.1 ± 10.8 years; 57.9% male), 229 deaths occurred. The warranty period of a CAC score of 0 was almost 15 years for individuals at low and intermediate risk with no significant differences regarding age and sex. A CAC score of 0 was associated with a vascular age of 1, 10, 20, and 30 years less than the chronological age of individuals between 50 and 59, 60 and 69, 70 and 79, and 80 years of age and older, respectively. The CAC score was the strongest predictor of death (hazard ratio: 2.67, 95% confidence interval: 2.29 to 3.11) that enabled discrimination and consistent reclassification beyond the FRS (area under the receiver-operating characteristic curve: 0.71 vs. 0.64, p < 0.001) and NCEP ATP III (area under the receiver-operating characteristic curve: 0.72 vs. 0.64, p < 0.001). Conclusions A CAC score of 0 confers a 15-year warranty period against mortality in individuals at low to intermediate risk that is unaffected by age or sex. Furthermore, in individuals considered at high risk by clinical risk scores, a CAC score of 0 confers better survival than in individuals at low to intermediate risk but with any CAC score.",

keywords = "computed tomography, coronary artery calcium, mortality, prognosis, warranty period",

author = "Valentina Valenti and {{\'O} Hartaigh}, Br{\'i}ain and Ran Heo and Iksung Cho and Joshua Schulman-Marcus and Heidi Gransar and Truong, {Quynh A.} and Shaw, {Leslee J.} and Joseph Knapper and Kelkar, {Anita A.} and Pratik Sandesara and Lin, {Fay Y.} and Sebastiano Sciarretta and Chang, {Hyuk Jae} and Callister, {Tracy Q.} and Min, {James K.}",

note = "Funding Information: This study was supported in part by grants from the National Institutes of Health (R01HL115150 and R01HL118019) and also funded in part by a generous gift from the Dalio Institute of Cardiovascular Imaging and the Michael Wolk Foundation. Dr. Truong is supported by NIH grants K23HL098370 and L30HL093896 and has received grant support from St. Jude Medical, American College of Radiology Imaging Network, and Duke Clinical Research Institute. Dr. Chang is supported by Leading Foreign Research Institute Recruitment Program through the National Research Foundation of Korea funded by the Ministry of Science, ICT, & Future Planning (MSIP) grant 2012027176. Dr. Min has served on the medical advisory boards of GE Healthcare, Arineta, AstraZeneca, and Bristol-Myers Squibb; on the Speakers Bureau of GE Healthcare; received research support from GE Healthcare, Vital Images, and Phillips Healthcare; serves as a consultant to AstraZeneca, Abbott Vascular, HeartFlow, NeoGraft Technologies, MyoKardia, and CardioDx; and is supported by grants NIH/NHLBI-R01 HL111141, NIH/NHLBI-R01 HL115150, NIH/NHLBI-R01 HL118019, NIH/NHLBI-U01 HL105907, and a grant from the Qatar National Research Foundation NPRP09-370-3-089. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Sherif Nagueh, MD, served as Guest Editor for this paper. Publisher Copyright: {\textcopyright} 2015 American College of Cardiology Foundation.",

year = "2015",

month = aug,

day = "1",

doi = "10.1016/j.jcmg.2015.01.025",

language = "English (US)",

volume = "8",

pages = "900--909",

journal = "JACC: Cardiovascular Imaging",

issn = "1936-878X",

publisher = "Elsevier Inc.",

number = "8",

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TY - JOUR

T1 - A 15-year warranty period for asymptomatic individuals without coronary artery calcium

T2 - A prospective follow-up of 9,715 individuals

AU - Valenti, Valentina

AU - Ó Hartaigh, Bríain

AU - Heo, Ran

AU - Cho, Iksung

AU - Schulman-Marcus, Joshua

AU - Gransar, Heidi

AU - Truong, Quynh A.

AU - Shaw, Leslee J.

AU - Knapper, Joseph

AU - Kelkar, Anita A.

AU - Sandesara, Pratik

AU - Lin, Fay Y.

AU - Sciarretta, Sebastiano

AU - Chang, Hyuk Jae

AU - Callister, Tracy Q.

AU - Min, James K.

N1 - Funding Information: This study was supported in part by grants from the National Institutes of Health (R01HL115150 and R01HL118019) and also funded in part by a generous gift from the Dalio Institute of Cardiovascular Imaging and the Michael Wolk Foundation. Dr. Truong is supported by NIH grants K23HL098370 and L30HL093896 and has received grant support from St. Jude Medical, American College of Radiology Imaging Network, and Duke Clinical Research Institute. Dr. Chang is supported by Leading Foreign Research Institute Recruitment Program through the National Research Foundation of Korea funded by the Ministry of Science, ICT, & Future Planning (MSIP) grant 2012027176. Dr. Min has served on the medical advisory boards of GE Healthcare, Arineta, AstraZeneca, and Bristol-Myers Squibb; on the Speakers Bureau of GE Healthcare; received research support from GE Healthcare, Vital Images, and Phillips Healthcare; serves as a consultant to AstraZeneca, Abbott Vascular, HeartFlow, NeoGraft Technologies, MyoKardia, and CardioDx; and is supported by grants NIH/NHLBI-R01 HL111141, NIH/NHLBI-R01 HL115150, NIH/NHLBI-R01 HL118019, NIH/NHLBI-U01 HL105907, and a grant from the Qatar National Research Foundation NPRP09-370-3-089. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Sherif Nagueh, MD, served as Guest Editor for this paper. Publisher Copyright: © 2015 American College of Cardiology Foundation.

PY - 2015/8/1

Y1 - 2015/8/1

N2 - Objectives The aim of this study was to examine the long-term prognosis in asymptomatic individuals with a coronary artery calcium (CAC) score of 0 and its associated warranty period. Background Emerging evidence supports a CAC score of 0 as a favorable cardiovascular short-to intermediate-term prognostic factor. Methods A total of 9,715 individuals undergoing CAC imaging were stratified by age, Framingham risk score (FRS), and National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) categories and followed for a mean of 14.6 years (range 12.9 to 16.8 years). Cox regression, area under the receiver-operating characteristic curve, and net reclassification information were used to assess all-cause mortality, discrimination, and reclassification of a CAC score of 0 compared with the FRS and NCEP ATP III, respectively. A warranty period was pre-defined as <1% annual mortality rate. Vascular age was estimated by linear regression. Results In 4,864 individuals with a baseline CAC score of 0 (mean age, 52.1 ± 10.8 years; 57.9% male), 229 deaths occurred. The warranty period of a CAC score of 0 was almost 15 years for individuals at low and intermediate risk with no significant differences regarding age and sex. A CAC score of 0 was associated with a vascular age of 1, 10, 20, and 30 years less than the chronological age of individuals between 50 and 59, 60 and 69, 70 and 79, and 80 years of age and older, respectively. The CAC score was the strongest predictor of death (hazard ratio: 2.67, 95% confidence interval: 2.29 to 3.11) that enabled discrimination and consistent reclassification beyond the FRS (area under the receiver-operating characteristic curve: 0.71 vs. 0.64, p < 0.001) and NCEP ATP III (area under the receiver-operating characteristic curve: 0.72 vs. 0.64, p < 0.001). Conclusions A CAC score of 0 confers a 15-year warranty period against mortality in individuals at low to intermediate risk that is unaffected by age or sex. Furthermore, in individuals considered at high risk by clinical risk scores, a CAC score of 0 confers better survival than in individuals at low to intermediate risk but with any CAC score.

AB - Objectives The aim of this study was to examine the long-term prognosis in asymptomatic individuals with a coronary artery calcium (CAC) score of 0 and its associated warranty period. Background Emerging evidence supports a CAC score of 0 as a favorable cardiovascular short-to intermediate-term prognostic factor. Methods A total of 9,715 individuals undergoing CAC imaging were stratified by age, Framingham risk score (FRS), and National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) categories and followed for a mean of 14.6 years (range 12.9 to 16.8 years). Cox regression, area under the receiver-operating characteristic curve, and net reclassification information were used to assess all-cause mortality, discrimination, and reclassification of a CAC score of 0 compared with the FRS and NCEP ATP III, respectively. A warranty period was pre-defined as <1% annual mortality rate. Vascular age was estimated by linear regression. Results In 4,864 individuals with a baseline CAC score of 0 (mean age, 52.1 ± 10.8 years; 57.9% male), 229 deaths occurred. The warranty period of a CAC score of 0 was almost 15 years for individuals at low and intermediate risk with no significant differences regarding age and sex. A CAC score of 0 was associated with a vascular age of 1, 10, 20, and 30 years less than the chronological age of individuals between 50 and 59, 60 and 69, 70 and 79, and 80 years of age and older, respectively. The CAC score was the strongest predictor of death (hazard ratio: 2.67, 95% confidence interval: 2.29 to 3.11) that enabled discrimination and consistent reclassification beyond the FRS (area under the receiver-operating characteristic curve: 0.71 vs. 0.64, p < 0.001) and NCEP ATP III (area under the receiver-operating characteristic curve: 0.72 vs. 0.64, p < 0.001). Conclusions A CAC score of 0 confers a 15-year warranty period against mortality in individuals at low to intermediate risk that is unaffected by age or sex. Furthermore, in individuals considered at high risk by clinical risk scores, a CAC score of 0 confers better survival than in individuals at low to intermediate risk but with any CAC score.

KW - computed tomography

KW - coronary artery calcium

KW - mortality

KW - prognosis

KW - warranty period

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A 15-year warranty period for asymptomatic individuals without coronary artery calcium: A prospective follow-up of 9,715 individuals

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