Long-Term Prognosis After Coronary Artery Calcium Scoring Among Low-Intermediate Risk Women and Men

Abstract

Background-Cardiovascular screening of women using traditional risk factors has been challenging, with results often classifying a majority of women as lower risk than men. The aim of this report was to determine the long-term prognosis of asymptomatic women and men classified at low-intermediate risk undergoing screening with coronary artery calcium (CAC) scoring. Methods and Results-A total of 2363 asymptomatic women and men with traditional risk factors aggregating into a lowintermediate Framingham risk score (6%-9.9%; 10-year predicted risk) underwent CAC scanning. Individuals were followed up for a median of 14.6 years. We estimated all-cause mortality using Cox proportional hazards models; hazard ratios with 95% confidence intervals were calculated. The area under the curve from a receiver operating characteristics curve analysis was calculated. There were 1072 women who were older (55.6 years) when compared with the 1291 men (46.7 years; P<0.0001), resulting in a greater prevalence and extent of CAC; 18.8% of women and 15.1% of men had a CAC score ≥100 (P=0.029). This older group of women had a 1.44-fold higher 15-year adjusted mortality hazard when compared with men (P=0.022). For women, the 15-year mortality ranged from 5.0% for those with a CAC score of 0 to 23.5% for those with a CAC score ≥400 (P<0.001). For men, the 15-year mortality ranged from 3.5% for those with a CAC score of 0 to 18.0% for those with a CAC score ≥400 (P<0.001). Women with CAC scores >10 had a higher mortality risk when compared with men. Conclusions-Our findings extend previous work that CAC effectively identifies high-risk women with a low-intermediate risk factor burden. These data require validation in external cohorts but lend credence to the use of CAC in women to improve risk detection algorithms that are currently based on traditional risk factors. (Circ Cardiovasc Imaging. 2016;9:e003742.

The role of nurse practitioners in primary care in optimizing risk stratification for coronary heart disease in Canadian women: an integrative review

“…Irrespective of age, the 15-year adjusted mortality hazard ratio in the women was 1.44-fold higher than in the men (P=0.022) (Kelkar et al, 2016). Appropriately, the 15-year mortality rate was only 5% in women with a CAC score of zero, but increased to 23.5% for women with an elevated coronary artery calcium score ≥ 400 (P<0.001) (Kelkar et al 2016).…”

“…In total, 18.8% of the women and 15.1% of men had CAC scores ≥ 100 (P=0.029) (Kelkar et al, 2016). Irrespective of age, the 15-year adjusted mortality hazard ratio in the women was 1.44-fold higher than in the men (P=0.022) (Kelkar et al, 2016).…”

“…Of these, CAC screening has the most compelling emerging data in women (Kelkar et al, 2016;McClelland et al, 2015;& Polonsky et al, 2010). The CAC score is calculated during a standard cardiac computed tomography scan and measures of the amount of calcium in the walls of the epicardial coronary arteries that supply the heart (Golf, 2014).…”

“…The latest transformative study by Kelkar et al (2016) explored the use of CAC screening for CV risk stratification in 2363 asymptomatic men and women with low to intermediate baseline FRS (Kelkar et al, 2016). All participants underwent CAC screening using standard cardiac computed tomography scanners with an average follow-up of 14.6 years.…”

“…All participants underwent CAC screening using standard cardiac computed tomography scanners with an average follow-up of 14.6 years. Allcause mortality was estimated with Cox proportional hazards models (Kelkar et al, 2016). The prevalence and extent of CAC was greater in women than in men, possibly because the 1072 women in the study were older (55.6 years) than the 1291 men (46.7 years) (Kelkar et al, 2016).…”