Coronary Artery Calcium and Noncardiovascular Outcomes

Study Questions:

Is coronary artery calcium (CAC) associated with noncardiovascular disease outcomes?


Data from MESA (Multi-Ethnic Study of Atherosclerosis) were used for the present analysis. Participants between 45 and 84 years of age without cardiovascular disease at baseline from six sites were followed for a median of 10.2 years. Information on age; sex; race; socioeconomic status; health insurance status; body mass index; physical activity; diet; tobacco use; number of medications used; blood pressure; total and high-density lipoprotein cholesterol; antihypertensive, aspirin, cholesterol medication; and diabetes was adjusted for in the multivariate models. The primary outcomes of interest were new diagnoses of noncardiovascular diseases including cancer, pneumonia, chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), deep vein thrombosis/pulmonary embolism, hip fracture, and dementia.


A total of 6,814 participants (mean age 62 years, 52.9% female) were included in this analysis, of which 38.5% were Caucasian, 27.8% African American, 22% Hispanic, and 11.8% Chinese. Among the participants, 50.1% (n = 3,416) had CAC = 0, 39.9% (n = 2,721) had CAC scores 1-400, and 9.9% (n = 677) had CAC scores >400. Those with CAC = 0 were more likely to be younger, female, and more physically active. Compared with those with CAC = 0, those with CAC >400 had an increased risk of cancer (hazard ratio [HR], 1.53; 95% confidence interval [CI], 1.18-1.99), CKD (HR, 1.70; 95% CI, 1.21-2.39), pneumonia (HR, 1.97; 95% CI, 1.37-2.82), COPD (HR, 2.71; 95% CI, 1.60-4.57), and hip fracture (HR, 4.29; 95% CI, 1.47-12.50). Dementia and deep vein thrombosis/pulmonary embolism were not associated with a CAC score >400. Participants with CAC = 0 had a decreased risk of cancer (HR, 0.76; 95% CI, 0.63-0.92), CKD (HR, 0.77; 95% CI, 0.60-0.98), COPD (HR, 0.61; 95% CI, 0.40-0.91), and hip fracture (HR, 0.31; 95% CI, 0.14-0.70) compared to those with CAC >0. CAC = 0 was not associated with less pneumonia, dementia, or deep vein thrombosis/pulmonary embolism. The results were attenuated, but remained significant after removing participants developing interim nonfatal coronary heart disease.


The investigators concluded that participants with elevated CAC were at increased risk of cancer, CKD, COPD, and hip fractures. Those with CAC = 0 are less likely to develop common age-related comorbid conditions, and represent a unique population of “healthy agers.”


A CAC score = 0 was more common among younger participants and those who were physically active; thus at lower risk for the outcomes examined. Furthermore, care is needed in the interpretation of analyses based on multiple comparisons.

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Noninvasive Imaging, Prevention, Vascular Medicine, Lipid Metabolism, Nonstatins, Exercise, Sleep Apnea

Keywords: Antihypertensive Agents, Aspirin, Atherosclerosis, Blood Pressure, Body Mass Index, Cholesterol, HDL, Diagnostic Imaging, Coronary Artery Disease, Dementia, Diabetes Mellitus, Exercise, Hip Fractures, Neoplasms, Pneumonia, Primary Prevention, Pulmonary Disease, Chronic Obstructive, Pulmonary Embolism, Renal Insufficiency, Chronic, Risk, Tobacco Use, Venous Thrombosis

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