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. 2022 Oct 26;17(10):e0276659.
doi: 10.1371/journal.pone.0276659. eCollection 2022.

Association between coronary artery calcium and all-cause mortality: A large single-center retrospective cohort study

Mu-Cyun Wang  1   2   3 , Che-Chen Lin  4 , Hsiu-Yin Chiang  4 , Hung-Lin Chen  4 , Hsiu-Chen Tsai  4 , Wen-Yuan Lin  1   2 , Hung-Chi Ho  2   5 , Chin-Chi Kuo  2   4   6
Affiliations

Association between coronary artery calcium and all-cause mortality: A large single-center retrospective cohort study

Mu-Cyun Wang et al. PLoS One. .

Abstract

Objective: Previous studies have revealed that coronary artery calcium is related to cardiovascular diseases and mortality. However, most studies have been conducted in Western countries and have excluded patients with pre-existing heart disease. We investigated the association between coronary artery calcium (CAC) and all-cause mortality in an Asian cohort and in subgroups stratified by age, sex, smoking, obesity, diabetes, cardiovascular disease, blood pressure, and biochemical parameters.

Methods: We conducted a retrospective cohort study on 4529 health examinees who underwent multidetector computed tomography in a tertiary medical center in Taiwan between 2011 and 2016. The mean follow-up was 3.5 years. Cox regression was used to estimate the relative hazards of death. Stratified analyses were performed.

Results: The all-cause mortality rates were 2.94, 4.88, 17.6, and 33.1 per 1000 person-years for CAC scores of 0, 1-100, 101-400, and >400, respectively. The multivariable adjusted hazard ratios (95% confidence intervals [CIs]) for all-cause mortality were 0.95 (0.53, 1.72), 1.87 (0.89, 3.90), and 3.05 (1.46, 6.39) for CAC scores of 1-100, 101-400, and >400, respectively, relative to a CAC score of 0. Compared with CAC ≤ 400, the HRs (95% CIs) for CAC > 400 were 6.46 (2.44, 17.15) and 1.94 (1.00, 3.76) in younger and older adults, respectively, indicating that age was a moderating variable (p = 0.02).

Conclusion: High CAC scores were associated with increased all-cause mortality. Although older adult patients had higher risks of death, the relative risk of death for patients with CAC > 400 was more prominent in people younger than 65 years.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Selection process of the study population.
MDCT, multidetector computed tomography; CMUH, China Medical University Hospital; CRDR, Clinical Research Data Repository; TCHO, total cholesterol; HDL, high-density lipoprotein; LDL, low-density lipoprotein; TG: triglyceride; SBP, systolic blood pressure.
Fig 2
Fig 2. Multivariable HRs (95% CIs) of mortality risks according to CAC stratified by other variables.
BMI, body mass index; CAC, coronary artery calcium; DM, diabetes mellitus; SBP, systolic blood pressure; TCHO, total cholesterol; HDL, high-density lipoprotein; eGFR, estimated glomerular filtration rate.
Fig 3
Fig 3. Unadjusted all-cause mortality rates according to coronary artery calcium (CAC) score by age and sex.
(A) Age < 65 years and (B) age ≥ 65 years.
See this image and copyright information in PMC

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