Abstract 16734: Coronary Artery Calcium as a Predictor of All-Cause, Cardiovascular and Coronary Heart Disease Mortality in Asian Americans: The Coronary Artery Calcium Consortium

Abstract

Introduction: Although coronary artery calcium (CAC) has been shown in multiple populations to be predictive of risk, very few studies have assessed its predictive value in Asian-Americans. We therefore assessed the value of CAC for cardiovascular and all-cause mortality risk prediction in Asian-Americans using data from the CAC Consortium, the largest observational cohort of clinical CAC scoring yet assembled. Methods: We included 1,621 Asian Americans from the CAC consortium. CAC was modeled in categorical (CAC 0; CAC 1 - 99; CAC 100 - 399; CAC ≥ 400) and continuous forms. Participants were followed over a median of 12 ± 4 years for all-cause mortality, cardiovascular disease (CVD) mortality and coronary heart disease (CHD) mortality. The predictive value of CAC for individual outcomes was assessed using multivariable-adjusted Cox proportional hazards regression models adjusted for traditional cardiovascular risk factors. Results were reported as hazard ratios (95% confidence intervals). Additionally, cubic spline graphs centered at CAC = 100 were generated for graphical presentations of CHD and CVD mortality hazards with increasing CAC score. Results: Mean (SD) age of the population was 54 (11.2) years and 64% were men. Approximately 49% had a CAC score=0. A total of 59 deaths, 16 CVD-specific deaths and 8 CHD-specific deaths were recorded over the duration of follow-up. Of a total of 794 participants in the CAC=0 group, only 9 deaths were recorded (0.93 per thousand person-years). There were no CVD or CHD deaths in the CAC=0 group over the duration of follow-up. Individuals with CAC ≥ 400 had approximately 3 times the multivariable-adjusted hazards of all-cause mortality compared against a reference of CAC=0. (Hazard ratio 3.3 (1.3 - 8.6)). Similarly, we noted statistically significant increases in risk of CHD (HR 2.6 (1.5 - 4.3)) and CVD (HR 2.3 (1.8 - 2.9)) mortality per unit increase in log (CAC + 1). Conclusion: Similar to more extensively studied race/ethnic groups, CAC is strongly predictive of all-cause and cardiovascular mortality in Asian Americans. These findings may help address the existing knowledge gaps for cardiovascular risk prediction in Asian Americans as recent guidelines have little data-driven advice for risk prediction in this population.