What is the clinical evidence from this study?

Study design: Cohort. Population: Asymptomatic with low-intermediate Framingham risk score (n=2363). Intervention: Coronary artery calcium (CAC) scoring vs. Men. Primary outcome: All-cause mortality (HR 1.44, p=0.022).

April 1, 2016Open Access

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

Key Result

Coronary artery calcium scoring effectively stratified 15-year mortality risk, ranging from 5.0% (CAC=0) to 23.5% (CAC≥400) in women and 3.5% to 18.0% in men.

Study Design

Type

Cohort (n=2,363)

Structured PICO

Does coronary artery calcium (CAC) scoring predict long-term mortality in asymptomatic women and men with low-intermediate Framingham risk?

Population

2363 asymptomatic women (n=1072, mean age 55.6) and men (n=1291, mean age 46.7) with traditional risk factors aggregating into a low-intermediate Framingham risk score (6%-9.9%; 10-year predicted risk).

Intervention

Coronary artery calcium (CAC) scoring

Outcome

All-cause mortality at median 14.6 years follow-uphard clinical

CAC scoring effectively stratifies long-term mortality risk in asymptomatic individuals with low-intermediate traditional risk, particularly identifying high-risk women.

Main Result

Effect estimate: HR 1.44

p-value: p=0.022

Limitations

These data require validation in external cohorts

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 low-intermediate 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; P10 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.