Coronary artery calcium scoring in low risk patients with family history of coronary heart disease: Validation of the SCCT guideline approach in the coronary artery calcium consortium

Ramzi Dudum, Omar Dzaye, Mohammadhassan Mirbolouk, Zeina A. Dardari, Olusola A. Orimoloye, Matthew J. Budoff, Daniel S. Berman, Alan Rozanski, Michael D. Miedema, Khurram Nasir, John A. Rumberger, Leslee Shaw, Seamus Whelton, Garth Graham, Michael Blaha

Research output: Contribution to journalArticle

Abstract

Background: The Society of Cardiovascular Computed Tomography (SCCT) recommends consideration of coronary artery calcium (CAC) scoring among individuals with a family history (FH) of coronary heart disease (CHD) and atherosclerotic cardiovascular disease (ASCVD) risk <5%. No dedicated study has examined the prognostic significance of CAC scoring among this population. Methods: The CAC Consortium is a multi-center observational cohort study from four clinical centers linked to long-term follow-up for cause-specific mortality. All CAC scans were physician referred and performed in patients without a history of CHD. Our analysis includes 14,169 patients with ASCVD scores <5% and self-reported FH of CHD. Results: This cohort had a mean age of 48.1 (SD 7.4), was 91.3% white, 47.4% female, had an average ASCVD score of 2.3% (SD 1.3), and 59.4% had a CAC = 0. The event rate for all-cause mortality was 1.2 per 1000 person-years, 0.3 per 1000 person-years for CVD-specific mortality, and 0.2 per 1000 person-years for CHD-specific mortality. In multivariable Cox proportional hazard models, those with CAC>100 had a 2.2 (95% CI 1.5–3.3) higher risk of all-cause mortality, 4.3 (95% CI 1.9–9.5) times higher risk of CVD-specific mortality, and a 10.4 (95% CI 3.2–33.7) times higher risk of CHD-specific mortality compared to individuals with CAC = 0. The NNS to detect CAC >100 in this sample was 9. Conclusion: In otherwise low risk patients with FH of CHD, CAC>100 were associated with increased risk of all-cause and CHD mortality with event rates in a range that may benefit with preventive pharmacotherapy. These data strongly support new SCCT recommendations regarding testing of patients with a family history of CHD.

Original languageEnglish (US)
JournalJournal of cardiovascular computed tomography
DOIs
StatePublished - Jan 1 2019

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Coronary Disease
Coronary Vessels
Tomography
Guidelines
Calcium
Mortality
Cardiovascular Diseases
Drug Therapy

Keywords

  • Computed tomography
  • Coronary artery calcium
  • Coronary heart disease
  • Family history

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Coronary artery calcium scoring in low risk patients with family history of coronary heart disease : Validation of the SCCT guideline approach in the coronary artery calcium consortium. / Dudum, Ramzi; Dzaye, Omar; Mirbolouk, Mohammadhassan; Dardari, Zeina A.; Orimoloye, Olusola A.; Budoff, Matthew J.; Berman, Daniel S.; Rozanski, Alan; Miedema, Michael D.; Nasir, Khurram; Rumberger, John A.; Shaw, Leslee; Whelton, Seamus; Graham, Garth; Blaha, Michael.

In: Journal of cardiovascular computed tomography, 01.01.2019.

Research output: Contribution to journalArticle

Dudum, Ramzi ; Dzaye, Omar ; Mirbolouk, Mohammadhassan ; Dardari, Zeina A. ; Orimoloye, Olusola A. ; Budoff, Matthew J. ; Berman, Daniel S. ; Rozanski, Alan ; Miedema, Michael D. ; Nasir, Khurram ; Rumberger, John A. ; Shaw, Leslee ; Whelton, Seamus ; Graham, Garth ; Blaha, Michael. / Coronary artery calcium scoring in low risk patients with family history of coronary heart disease : Validation of the SCCT guideline approach in the coronary artery calcium consortium. In: Journal of cardiovascular computed tomography. 2019.
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abstract = "Background: The Society of Cardiovascular Computed Tomography (SCCT) recommends consideration of coronary artery calcium (CAC) scoring among individuals with a family history (FH) of coronary heart disease (CHD) and atherosclerotic cardiovascular disease (ASCVD) risk <5{\%}. No dedicated study has examined the prognostic significance of CAC scoring among this population. Methods: The CAC Consortium is a multi-center observational cohort study from four clinical centers linked to long-term follow-up for cause-specific mortality. All CAC scans were physician referred and performed in patients without a history of CHD. Our analysis includes 14,169 patients with ASCVD scores <5{\%} and self-reported FH of CHD. Results: This cohort had a mean age of 48.1 (SD 7.4), was 91.3{\%} white, 47.4{\%} female, had an average ASCVD score of 2.3{\%} (SD 1.3), and 59.4{\%} had a CAC = 0. The event rate for all-cause mortality was 1.2 per 1000 person-years, 0.3 per 1000 person-years for CVD-specific mortality, and 0.2 per 1000 person-years for CHD-specific mortality. In multivariable Cox proportional hazard models, those with CAC>100 had a 2.2 (95{\%} CI 1.5–3.3) higher risk of all-cause mortality, 4.3 (95{\%} CI 1.9–9.5) times higher risk of CVD-specific mortality, and a 10.4 (95{\%} CI 3.2–33.7) times higher risk of CHD-specific mortality compared to individuals with CAC = 0. The NNS to detect CAC >100 in this sample was 9. Conclusion: In otherwise low risk patients with FH of CHD, CAC>100 were associated with increased risk of all-cause and CHD mortality with event rates in a range that may benefit with preventive pharmacotherapy. These data strongly support new SCCT recommendations regarding testing of patients with a family history of CHD.",
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author = "Ramzi Dudum and Omar Dzaye and Mohammadhassan Mirbolouk and Dardari, {Zeina A.} and Orimoloye, {Olusola A.} and Budoff, {Matthew J.} and Berman, {Daniel S.} and Alan Rozanski and Miedema, {Michael D.} and Khurram Nasir and Rumberger, {John A.} and Leslee Shaw and Seamus Whelton and Garth Graham and Michael Blaha",
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T1 - Coronary artery calcium scoring in low risk patients with family history of coronary heart disease

T2 - Validation of the SCCT guideline approach in the coronary artery calcium consortium

AU - Dudum, Ramzi

AU - Dzaye, Omar

AU - Mirbolouk, Mohammadhassan

AU - Dardari, Zeina A.

AU - Orimoloye, Olusola A.

AU - Budoff, Matthew J.

AU - Berman, Daniel S.

AU - Rozanski, Alan

AU - Miedema, Michael D.

AU - Nasir, Khurram

AU - Rumberger, John A.

AU - Shaw, Leslee

AU - Whelton, Seamus

AU - Graham, Garth

AU - Blaha, Michael

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: The Society of Cardiovascular Computed Tomography (SCCT) recommends consideration of coronary artery calcium (CAC) scoring among individuals with a family history (FH) of coronary heart disease (CHD) and atherosclerotic cardiovascular disease (ASCVD) risk <5%. No dedicated study has examined the prognostic significance of CAC scoring among this population. Methods: The CAC Consortium is a multi-center observational cohort study from four clinical centers linked to long-term follow-up for cause-specific mortality. All CAC scans were physician referred and performed in patients without a history of CHD. Our analysis includes 14,169 patients with ASCVD scores <5% and self-reported FH of CHD. Results: This cohort had a mean age of 48.1 (SD 7.4), was 91.3% white, 47.4% female, had an average ASCVD score of 2.3% (SD 1.3), and 59.4% had a CAC = 0. The event rate for all-cause mortality was 1.2 per 1000 person-years, 0.3 per 1000 person-years for CVD-specific mortality, and 0.2 per 1000 person-years for CHD-specific mortality. In multivariable Cox proportional hazard models, those with CAC>100 had a 2.2 (95% CI 1.5–3.3) higher risk of all-cause mortality, 4.3 (95% CI 1.9–9.5) times higher risk of CVD-specific mortality, and a 10.4 (95% CI 3.2–33.7) times higher risk of CHD-specific mortality compared to individuals with CAC = 0. The NNS to detect CAC >100 in this sample was 9. Conclusion: In otherwise low risk patients with FH of CHD, CAC>100 were associated with increased risk of all-cause and CHD mortality with event rates in a range that may benefit with preventive pharmacotherapy. These data strongly support new SCCT recommendations regarding testing of patients with a family history of CHD.

AB - Background: The Society of Cardiovascular Computed Tomography (SCCT) recommends consideration of coronary artery calcium (CAC) scoring among individuals with a family history (FH) of coronary heart disease (CHD) and atherosclerotic cardiovascular disease (ASCVD) risk <5%. No dedicated study has examined the prognostic significance of CAC scoring among this population. Methods: The CAC Consortium is a multi-center observational cohort study from four clinical centers linked to long-term follow-up for cause-specific mortality. All CAC scans were physician referred and performed in patients without a history of CHD. Our analysis includes 14,169 patients with ASCVD scores <5% and self-reported FH of CHD. Results: This cohort had a mean age of 48.1 (SD 7.4), was 91.3% white, 47.4% female, had an average ASCVD score of 2.3% (SD 1.3), and 59.4% had a CAC = 0. The event rate for all-cause mortality was 1.2 per 1000 person-years, 0.3 per 1000 person-years for CVD-specific mortality, and 0.2 per 1000 person-years for CHD-specific mortality. In multivariable Cox proportional hazard models, those with CAC>100 had a 2.2 (95% CI 1.5–3.3) higher risk of all-cause mortality, 4.3 (95% CI 1.9–9.5) times higher risk of CVD-specific mortality, and a 10.4 (95% CI 3.2–33.7) times higher risk of CHD-specific mortality compared to individuals with CAC = 0. The NNS to detect CAC >100 in this sample was 9. Conclusion: In otherwise low risk patients with FH of CHD, CAC>100 were associated with increased risk of all-cause and CHD mortality with event rates in a range that may benefit with preventive pharmacotherapy. These data strongly support new SCCT recommendations regarding testing of patients with a family history of CHD.

KW - Computed tomography

KW - Coronary artery calcium

KW - Coronary heart disease

KW - Family history

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