Key result
Presence of CAC is linked to ~2.1-fold higher 5-year all-cause mortality versus CAC=0.
Why the study?
Although clinical CAD may be associated with a greater risk of non-cardiovascular and cancer events, whether coronary artery calcium as a preclinical marker of CAD similarly predicts non-cardiovascular and cancer-related mortality was uncertain.
Does the presence of coronary artery calcium (CAC > 0) predict 5-year all-cause, non-cardiovascular, and cancer-related mortality compared to CAC = 0 in patients at primary coronary risk undergoing PET/CT stress testing?
Cohort (n=40,006)
Does the presence of coronary artery calcium (CAC > 0) predict 5-year all-cause, non-cardiovascular, and cancer-related mortality compared to CAC = 0 in patients at primary coronary risk undergoing PET/CT stress testing?
In patients at primary coronary risk undergoing PET/CT, the presence of coronary artery calcium (CAC > 0) significantly predicts higher 5-year all-cause, cardiovascular, non-cardiovascular, and cancer-related mortality compared to CAC = 0.
Answers are grounded in this paper and cite their sources.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“We know that not having any coronary artery calcium is a predictor of being in good coronary health, but we were surprised to find that it may also be a sign you're in good general health. Someone's coronary artery calcium score could be a more powerful predictor of a person's overall health than we previously thought.”
“This may help uncover the mechanism of why a coronary artery calcium score predicts death due to non-coronary artery problems. It's not clear to us right now, and it requires more study, but it's a very interesting observation and suggests that coronary artery calcium has prognostic value beyond just heart attacks and other heart-related causes.”
CAC>0 signals higher all-cause mortality; extends CV risk data to non-CV outcomes but leaves causal links open.
Background Coronary artery calcium (CAC) is a strong predictor of coronary artery disease (CAD) and global cardiovascular risk, and CAC=0 is a highly favorable prognostic marker. A few reports suggest that clinical CAD also may be associated with a greater risk of non-cardiovascular and cancer risk. Whether CAC as a preclinical marker of CAD similarly predicts non-CV risk is uncertain. Objective To determine whether CAC is prognostic of 5-year all-cause, non-cardiovascular- and cancer-related mortality. Methods We searched the institutional electronic medical record (eMR) database for patients (pts) at primary coronary risk who underwent positron emission tomography/computed tomography (PET/CT) stress testing and had a 5-year follow-up. Cause-specific mortality was determined by agnostic chart review. We compared unadjusted and age/sex-adjusted total and cause-specific mortality rates between CAC=0 and CAC>0 groups. Logistic regression was used to test for age/sex adjusted between-group odds ratio differences. Results The eMR search identified 40,006 pts undergoing PET/CT who were at primary coronary risk. Mean age was 65.8 [11.9] y; 48.7% were female; 7959 (19.9%) were CAC=0 by CT, and 32,047 were CAC>0. There were 230 deaths (2.89%) among CAC=0 and 2830 deaths (8.83%) among CAC>0 pts, for a relative risk (RR) of 3.06 for CAC>0 (p<0.001). The age/sex adjusted total mortality risk for CAC>0 was 2.11 (CI, 1.83-2.43, p<0.001). The unadjusted and adjusted risks for CV-, non-CV-, and cancer-related deaths are shown in Tables 1 and 2. CAC>0 predicted a greater risk of death not only for total mortality and CV-related mortality but also for non-CV and cancer-related death. Conclusions In this large, integrated healthcare system experience, the presence of CAC predicted a greater risk not only for CV-death but also for all-cause, non-CV, and cancer deaths. The implications of CAC go beyond marking the risk of CAD-related and all CV events to also marking global vascular health, cancer risk, and overall survival. The mechanisms of this association require further study, but CAC is a predictor of calcification in other vascular beds and may be a marker of multiorgan involvement in the cardiometabolic syndrome. CAD and CAC may impact cancer risk through altered immune surveillance.
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Anderson et al. (2026) conducted a cohort in Primary coronary risk undergoing PET/CT stress testing (n=40,006). Coronary artery calcium present (CAC>0) vs. Absence of coronary artery calcium (CAC=0) was evaluated on 5-year all-cause mortality (OR 2.11, 95% CI 1.83-2.43, p=<0.001). Presence of coronary artery calcium (CAC>0) vs CAC=0 predicted higher 5-year all-cause mortality (8.83% vs 2.89%; age/sex-adjusted OR 2.11, 95% CI 1.83-2.43; p<0.001).
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