title: Traditional cardiovascular disease risk factors associated with one-year all-cause mortality among those with coronary artery calcium scores ≥400.
abstract: BACKGROUND
  Coronary artery calcium (CAC) reflects coronary plaque burden and independently predicts all-cause mortality. There is marked heterogeneity in the prognosis of individuals with a high burden of subclinical atherosclerosis, yet little research has focused on the proximate determinants of poor outcomes in this subgroup.
  
  
  METHODS
  Among 4234 persons with baseline CAC ≥400, multivariable Cox proportional hazards models were used to study the association of traditional cardiovascular risk factors with 1-year all-cause mortality.
  
  
  RESULTS
  The mean age was 64 ± 10 years, with 56% male and a median CAC score of 809 (IQR 761). In multivariable models, diabetes, cigarette smoking, age (per SD), CAC (per SD) and dyslipidemia were significantly associated with all-cause mortality at 1 year: HR (95% confidence interval) = 2.62 (1.55-4.43), 2.42 (1.41-4.15), 1.52 (1.16-1.99), 1.33 (CAC 1.11-1.56) and 0.58 (0.34-0.98) respectively. There was no association with hypertension [HR (95% confidence interval) = 0.90 (0.55-1.47)].
  
  
  CONCLUSIONS
  Smoking and diabetes are strongly associated with one-year all-cause mortality among persons with extensive CAC, perhaps suggesting that these risk factors serve as triggers of acute events.
authors.affiliation: The Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Baltimore, MD, USA.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Al Rifai
authors.affiliation: The Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Baltimore, MD, USA.
authors.forename: John W
authors.initials: JW
authors.lastname: McEvoy
authors.affiliation: The Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Baltimore, MD, USA; Center for Prevention and Wellness, Baptist Health South Florida, Miami, FL, USA.
authors.forename: Khurram
authors.initials: K
authors.lastname: Nasir
authors.affiliation: Princeton Longevity Center, Princeton, NJ, USA.
authors.forename: Jon
authors.initials: J
authors.lastname: Rumberger
authors.affiliation: The Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Baltimore, MD, USA.
authors.forename: David
authors.initials: D
authors.lastname: Feldman
authors.affiliation: Division of Cardiology, Harbor-UCLA Medical Center, Torrance, CA, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Budoff
authors.affiliation: The Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Baltimore, MD, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Blaha
mesh_terms: D000368:Aged; D050197:Atherosclerosis / Q000175:diagnosis / Q000378:metabolism / Q000401:mortality; D002114:Calcinosis / Q000175:diagnosis / Q000378:metabolism*; D002118:Calcium / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000378:metabolism* / Q000401:mortality*; D002423:Cause of Death; D015331:Cohort Studies; D003331:Coronary Vessels / Q000473:pathology*; D048909:Diabetes Complications / Q000175:diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012307:Risk Factors
chemical_list: D002118:Calcium
keywords: All-cause mortality; Cardiovascular risk factors; Subclinical atherosclerosis