Abstract 14238: Coronary Artery Calcium for Stroke Mortality Prediction: The Coronary Artery Calcium Consortium

Introduction: Coronary artery calcification (CAC) is a noninvasive biomarker of atherosclerotic plaque burden in the general population and predicts coronary heart disease and mortality. This study examined whether CAC predicts stroke mortality independent of established traditional cardiovascular risk factors. Methods: We included 66,511 participants (mean age: 54.4±10.6 years; 33.0% women) from the prospective, multi-center CAC Consortium study without stroke or coronary heart disease (CHD). CAC was assessed at the study baseline with a cardiac-gated computed tomography scan and categorized as absent/present and 0, 1-99, 100-299, and ≥300 Agatston Units (AU). To examine CAC as a predictor for stroke mortality, we utilized multivariable-adjusted Fine and Gray competing risk regression models, adjusting for traditional cardiovascular risk factors. For sensitivity analysis, we excluded patients whose death certificates indicated a possible stroke-complication of CHD (excluded, n=8). Results: During a mean follow-up period of 12.3±3.9 years, there were 160 stroke deaths. Compared to individuals without CAC, those with CAC >0 AU had a higher incidence of stroke mortality (0.31 vs. 0.06 per 1,000 person-years). After adjusting for traditional risk factors, individuals with CAC had a significantly higher sub-distribution hazard ratio (SHR) for stroke mortality than those without CAC (SHR: 2.17; [95% CI:1.32-3.56). In addition, compared with individuals without CAC, the risk of stroke mortality significantly increased as CAC increased (SHR range:1.77; [95%CI: 1.03-3.05]) - 3.09; [95% CI:1.72-5.54]). The results obtained from our sensitivity analysis were similar (Table). Conclusions: CAC was associated with mortality from stroke independent of traditional cardiovascular risk factors. While a marker of coronary atherosclerosis burden, CAC should be considered a risk marker for all types of atherosclerotic cardiovascular disease mortality.