Abstract 13667: Coronary Artery Calcium for the Prediction of All-Cause and Cause-Specific Mortality Among Individuals With Obesity: The Coronary Artery Calcium Consortium

Abstract

Introduction: New therapies for obesity point to the need for greater risk stratification in this population. While the role of coronary artery calcium (CAC) for ASCVD risk prediction among key subgroups, e.g., those with intermediate ASCVD risk, is well established, the effectiveness of CAC for risk stratification in obesity, in which imaging is limited due to reduced signal-to-noise ratio, has not been well studied. Methods: We used data from 9,334 men and women (mean age 53.3 ± 9.7 years; 32.1% women) with BMI ≥30 kg/m2 from the CAC Consortium, a retrospectively assembled cohort of individuals with no prior CVD history referred for CAC scan. We categorized CAC as absent/present and 0, 1-99, 100-299, ≥300 AU. We then evaluated the predictive value of CAC for all-cause and cause-specific mortality (cardiovascular and CHD) using multivariable-adjusted Cox proportional hazard and competing risks regression, respectively. Results: Of the 9,334 participants, 5,461 (58.5%) had CAC. Compared to persons without CAC, those with CAC >0 had higher incidence of all-cause (5.65 vs 1.97 per 1,000 person-years), cardiovascular (1.89 vs 0.43 per 1,000 person-years), and CHD mortality (1.04 vs 0.19 per 1,000 person-years), after a mean follow-up of 10.8 ± 3.0 years. After adjusting for age, sex, and cardiovascular risk factors, individuals with CAC > 0 had significantly higher risk of all-cause (HR 1.39; 95%CI 1.07 - 1.80), cardiovascular (SHR 2.06; 95%CI 1.20 - 3.54), and CHD mortality (SHR 2.72; 95%CI 1.21 - 6.14), compared to those without CAC. Of note, CAC ≥300 was associated with a markedly higher risk of all-cause, cardiovascular, and CHD mortality, even when restricting to persons with ≥ Class II obesity (≥35 kg/m2) (Table) Conclusions: Among individuals with obesity, CAC strongly predicts all-cause, cardiovascular, and CHD mortality and may therefore serve as an effective risk stratification tool to prioritize the allocation of therapies for weight management in this population.