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

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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 languageEnglish
Pages (from-to)900-909
Number of pages10
JournalJACC: Cardiovascular Imaging
Volume8
Issue number8
DOIs
Publication statusPublished - 2015 Aug 1

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Coronary Vessels
Calcium
ROC Curve
Cholesterol
Education
Blood Vessels
Mortality
Linear Models
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Valenti, Valentina ; Ó Hartaigh, Bríain ; Heo, Ran ; Cho, Iksung ; Schulman-Marcus, Joshua ; Gransar, Heidi ; Truong, Quynh A. ; Shaw, Leslee J. ; Knapper, Joseph ; Kelkar, Anita A. ; Sandesara, Pratik ; Lin, Fay Y. ; Sciarretta, Sebastiano ; Chang, Hyuk Jae ; Callister, Tracy Q. ; Min, James K. / A 15-year warranty period for asymptomatic individuals without coronary artery calcium : A prospective follow-up of 9,715 individuals. In: JACC: Cardiovascular Imaging. 2015 ; Vol. 8, No. 8. pp. 900-909.
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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.",
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.}",
year = "2015",
month = "8",
day = "1",
doi = "10.1016/j.jcmg.2015.01.025",
language = "English",
volume = "8",
pages = "900--909",
journal = "JACC: Cardiovascular Imaging",
issn = "1936-878X",
publisher = "Elsevier Inc.",
number = "8",

}

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

A 15-year warranty period for asymptomatic individuals without coronary artery calcium : A prospective follow-up of 9,715 individuals. / Valenti, Valentina; Ó Hartaigh, Bríain; Heo, Ran; Cho, Iksung; Schulman-Marcus, Joshua; Gransar, Heidi; Truong, Quynh A.; Shaw, Leslee J.; Knapper, Joseph; Kelkar, Anita A.; Sandesara, Pratik; Lin, Fay Y.; Sciarretta, Sebastiano; Chang, Hyuk Jae; Callister, Tracy Q.; Min, James K.

In: JACC: Cardiovascular Imaging, Vol. 8, No. 8, 01.08.2015, p. 900-909.

Research output: Contribution to journalArticle

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.

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.

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