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3. The Power of the Coronary Artery Calcification Scan and More.pptx

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2017 Ivor Cummins BE(Chem) CEng
An Engineering Guide to
Chronic Disease Avoidance
From Measuring it - to
Managing it
Ivor Cummins BE(Chem) CEng MIEI PMP®
David Bobbett and his Irish Heart Disease Awareness charity
(http://www.IHDA.ie/)
If you Don’t Measure It
- it Don’t Get Fixed
PART 1
Rule Zero: Always Honor Pareto
20% of the input (Time, Resources,
Effort)
Account for 80% of the Output (Results,
Rewards)
Rule Zero: Always Honor Pareto
20% of the Root Causes for the
Issue…
Account for 80% of the Issue Resolution
David Bobbett – one of the Saved
* CEO/Owner of H&K International
* Jogging ~4 times per week
* Described by docs as “bulletproof”
* 52 years old, slim and fit non-smoker

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3. The Power of the Coronary Artery Calcification Scan and More.pptx

  • 1. 2017 Ivor Cummins BE(Chem) CEng An Engineering Guide to Chronic Disease Avoidance From Measuring it - to Managing it Ivor Cummins BE(Chem) CEng MIEI PMP®
  • 2. David Bobbett and his Irish Heart Disease Awareness charity (http://www.IHDA.ie/)
  • 3. If you Don’t Measure It - it Don’t Get Fixed PART 1
  • 4. Rule Zero: Always Honor Pareto 20% of the input (Time, Resources, Effort) Account for 80% of the Output (Results, Rewards)
  • 5. Rule Zero: Always Honor Pareto 20% of the Root Causes for the Issue… Account for 80% of the Issue Resolution
  • 6. David Bobbett – one of the Saved * CEO/Owner of H&K International * Jogging ~4 times per week * Described by docs as “bulletproof” * 52 years old, slim and fit non-smoker
  • 7. David Bobbett – one of the Saved * CEO/Owner of H&K International * Jogging ~4 times per week * 15 executive medicals… * All Bloods Good * Fittest 10% for age * Described by docs as “bulletproof” * 52 years old, slim and fit non-smoker * Treadmill Stress Tests/ECG
  • 8. David Bobbett – one of the Saved * CEO/Owner of H&K International * Jogging ~4 times per week * 15 executive medicals… * All Bloods Good * Fittest 10% for age * Described by docs as “bulletproof” * 52 years old, slim and fit non-smoker * Treadmill Stress Tests/ECG
  • 9. David Bobbett – one of the Saved * CAC=906 ! Worst 1% for age. * CAC supersedes all tests * ~75% chance of Heart Attack * CEO/Owner of H&K International * Jogging ~4 times per week * 15 executive medicals… * All Bloods Good * Fittest 10% for age * Described by docs as “bulletproof” * 52 years old, slim and fit non-smoker * Treadmill Stress Tests/ECG
  • 10. David Bobbett – one of the Saved * CAC=906 ! Worst 1% for age. * CAC supersedes all tests * ~75% chance of Heart Attack * Angio shows severe blockages * No Surgery – lifestyle + meds fix * David takes 6mths to study * CEO/Owner of H&K International * Jogging ~4 times per week * 15 executive medicals… * All Bloods Good * Fittest 10% for age * Described by docs as “bulletproof” * 52 years old, slim and fit non-smoker * Treadmill Stress Tests/ECG
  • 11. David Bobbett – one of the Saved * CAC=906 ! Worst 1% for age. * CAC supersedes all tests * ~75% chance of Heart Attack * CEO/Owner of H&K International * Jogging ~4 times per week * 15 executive medicals… * All Bloods Good * Fittest 10% for age * Described by docs as “bulletproof” * 52 years old, slim and fit non-smoker * Treadmill Stress Tests/ECG * Angio shows severe blockages * David takes 6mths to study * He was diabetic, undiagnosed * But Heart Disease IS resolvable * Nutrition is primary ROOT CAUSE * No Surgery – lifestyle + meds fix
  • 12. David Bobbett – one of the Saved * CAC=906 ! Worst 1% for age. * CAC supersedes all tests * ~50% chance of Heart Attack * He was diabetic, undiagnosed * But Heart Disease IS resolvable * Founded www.IHDA.ie * Funded The Widowmaker Movie * Total Philanthropy * Resolved his disease process * CEO/Owner of H&K International * Jogging ~4 times per week * 15 executive medicals… * All Bloods Good * Fittest 10% for age * Described by docs as “bulletproof” * 52 years old, slim and fit non-smoker * Treadmill Stress Tests/ECG * Angio shows severe blockages * David takes 6mths to study * Nutrition is primary ROOT CAUSE * No Surgery – lifestyle + meds fix
  • 14. Google “Budoff Ivor” “Progression to Disability and/or Death… Passage of Time…
  • 15. Google “Budoff Ivor” Passage of Time… “Progression to Disability and/or Death…
  • 16. Google “Budoff Ivor” Passage of Time… “Progression to Disability and/or Death…
  • 17. Google “Budoff Ivor” Passage of Time… HEART ATTACK! “Progression to Disability and/or Death…
  • 18. Maybe 10-20 Years... Passage of Time… HEART ATTACK! “Progression to Disability and/or Death…
  • 19. Passage of Time… Stabilization “Progression to Disability and/or Death…
  • 20. CAC: THE MASTER MEASURE Google “Budoff Ivor”
  • 21. “We Stand on the Shoulder’s of Giants…” Bruce Brundage Cardiologist Former Professor David Geffan School of Medicine UCLA Doug Boyd Physicist, Inventor of CAC Technology Former Professor of Radiology (Physics) UCSF Harvey S. Hecht Cardiologist Professor Mount Sinai Medical Centre New York John A. Rumberger Cardiologist Princeton Longevity Centre Matthew J. Budoff Cardiologist Professor of Medicine UCLA Arthur Agatston Cardiologist Associate Professor of Medicine University of Miami
  • 22. Calcium Score Risk Equivalent 10-Year Event Rate, % 0 Very low 1.4 1 – 100 Low 4.1 101 – 400 Intermediate 15 >400 High 26 >1000 Very high 37 J Am Coll Cardiol Img. 2015;8(5):579-596 Based on 100’s of thousands of subjects Reproducible and quantifiable CAC: THE MASTER MEASURE FOR HEART ATTACKS ? ? ?
  • 23. Calcium Score Risk Equivalent 10-Year Event Rate, % 0 Very low 1.4 1 – 100 Low 4.1 101 – 400 Intermediate 15 >400 High 26 >1000 Very high 37 J Am Coll Cardiol Img. 2015;8(5):579-596 Based on 100’s of thousands of subjects Reproducible and quantifiable CAC: THE MASTER MEASURE FOR HEART ATTACKS ? ? ?
  • 24. Calcium Score Risk Equivalent Patients Dead after 12 Years 0 – 10 Very low 0.6% 11 – 100 Low 2.2% 101 – 400 Intermediate 5.5% 401 – 1000 High 7.0% >1000 Very high 23.1% J Am Coll Cardiol. 2007 May 8;49(18):1860-70. 25,253 patients followed for 12 years… CAC: THE MASTER MEASURE FOR DEATH ? ? ?
  • 25. Calcium Score Risk Equivalent Patients Dead after 12 Years 0 – 10 Very low 0.6% 11 – 100 Low 2.2% 101 – 400 Intermediate 5.5% 401 – 1000 High 7.0% >1000 Very high 23.1% J Am Coll Cardiol. 2007 May 8;49(18):1860-70. 25,253 patients followed for 12 years… CAC: THE MASTER MEASURE FOR DEATH ? ? ?
  • 26. Calcium Score Risk Equivalent Patients Dead after 12 Years 0 – 10 Very low 0.6% 11 – 100 Low 2.2% 101 – 400 Intermediate 5.5% 401 – 1000 High 7.0% >1000 Very high 23.1% J Am Coll Cardiol. 2007 May 8;49(18):1860-70. 25,253 patients followed for 12 years… CAC: THE MASTER MEASURE FOR DEATH
  • 27. Calcium Score Risk Equivalent Patients Dead after 12 Years 0 – 10 Very low 0.6% 11 – 100 Low 2.2% 101 – 400 Intermediate 5.5% 401 – 1000 High 7.0% >1000 Very high 23.1% J Am Coll Cardiol. 2007 May 8;49(18):1860-70. 25,253 patients followed for 12 years… CAC: THE MASTER MEASURE FOR DEATH
  • 28. 10 15 20 25 5 45-54 Heart Attack Rate in 10 Years 55-64 65-74 75-84 CAC=0 CAC=1-100 CAC>100 Age: Mayo Clin Proc. 2014 October ; 89(10): 1350–135 CAC – the Ultimate Test
  • 29. 10 15 20 25 5 45-54 Heart Attack Rate in 10 Years 55-64 65-74 75-84 CAC=0 CAC=1-100 CAC>100 Age: Mayo Clin Proc. 2014 October ; 89(10): 1350–135 CAC – the Ultimate Test
  • 30. Can We Intervene - to Slow or Stop Progression?
  • 31. The Key is to Slow or Stop PROGRESSION “Progression of Coronary Artery Calcium and Risk of First Myocardial Infarction in Patients Receiving Cholesterol- Lowering Therapy” Score Increase >15% per yr Score at Start 100-1000 ~50 % Heart Events ~3% Heart Events Score Increase <15% per yr Score at Start 100-1000
  • 34. Smoking Vs CAC Score…and Taking ACTION “Prognostic value of coronary artery calcium screening in asymptomatic smokers and non-smokers” European Heart
  • 35. Smoking Vs CAC Score…and Taking ACTION “Prognostic value of coronary artery calcium screening in asymptomatic smokers and non-smokers” European Heart NON-SMOKERS CAC Less Than 10 …5 Years Pass by…
  • 36. Smoking Vs CAC Score…and Taking ACTION “Prognostic value of coronary artery calcium screening in asymptomatic smokers and non-smokers” European Heart SMOKERS CAC Less Than 10 NON-SMOKERS CAC Less Than 10 …5 Years Pass by… …5 Years Pass by…
  • 37. Smoking Vs CAC Score…and Taking ACTION NON-SMOKERS CAC More Than 1000 “Prognostic value of coronary artery calcium screening in asymptomatic smokers and non-smokers” European Heart SMOKERS CAC Less Than 10 NON-SMOKERS CAC Less Than 10 …5 Years Pass by… …5 Years Pass by… …5 Years Pass by…
  • 38. Smoking Vs CAC Score…and Taking ACTION NON-SMOKERS CAC More Than 1000 “Prognostic value of coronary artery calcium screening in asymptomatic smokers and non-smokers” European Heart SMOKERS CAC Less Than 10 NON-SMOKERS CAC Less Than 10 …5 Years Pass by… …5 Years Pass by… …5 Years Pass by…
  • 39. Diabetes and CAC Your Warranty Revealed…
  • 40. Warranty Periods Explained… DIABETICS NON- DIABETICS Absence of Coronary Artery Calcium Identifies Asymptomatic Diabetic Individuals at Low Near-Term But Not Long-Term Risk of Mortality Circ Cardiovasc Imaging. 2016;9:e003528. DOI: 10.1161/CIRCIMAGING.115.003528.
  • 41. Warranty Periods Explained… NON- DIABETICS: warranty for ~15 years… DIABETICS NON- DIABETICS Absence of Coronary Artery Calcium Identifies Asymptomatic Diabetic Individuals at Low Near-Term But Not Long-Term Risk of Mortality Circ Cardiovasc Imaging. 2016;9:e003528. DOI: 10.1161/CIRCIMAGING.115.003528.
  • 42. Warranty Periods Explained… NON- DIABETICS: warranty for ~15 years… DIABETICS NON- DIABETICS DIABETICS ~5 Years Absence of Coronary Artery Calcium Identifies Asymptomatic Diabetic Individuals at Low Near-Term But Not Long-Term Risk of Mortality Circ Cardiovasc Imaging. 2016;9:e003528. DOI: 10.1161/CIRCIMAGING.115.003528.
  • 43. Warranty Periods Explained… Absence of Coronary Artery Calcium Identifies Asymptomatic Diabetic Individuals at Low Near-Term But Not Long-Term Risk of Mortality Circ Cardiovasc Imaging. 2016;9:e003528. DOI: 10.1161/CIRCIMAGING.115.003528. NON- DIABETICS: warranty for ~15 years… DIABETICS ~5 Years DIABETICS NON- DIABETICS Re-Check CAC for Diabetics: 1. Many of them will no longer be zero 2. their Athero Burden could be approaching cliff ! 3. Plaque Rupture & MI’s will begin to ramp !
  • 44. Warranty Periods Explained… Absence of Coronary Artery Calcium Identifies Asymptomatic Diabetic Individuals at Low Near-Term But Not Long-Term Risk of Mortality Circ Cardiovasc Imaging. 2016;9:e003528. DOI: 10.1161/CIRCIMAGING.115.003528. NON- DIABETICS: warranty for ~15 years… DIABETICS ~5 Years DIABETICS NON- DIABETICS Re-Check CAC for ‘non-Diabetics’: 1. Who will no longer be zero? 2. Who now has risky Athero burden? 3. Which of these guys have now become diabetic ?? Re-Check CAC for Diabetics: 1. Many of them will no longer be zero 2. their Athero Burden could be approaching cliff ! 3. Plaque Rupture & MI’s will begin to ramp !
  • 45. Warranty Periods Explained… NON- DIABETICS: warranty for ~15 years… DIABETICS NON- DIABETICS NON- DIABETICS DIABETICS Absence of Coronary Artery Calcium Identifies Asymptomatic Diabetic Individuals at Low Near-Term But Not Long-Term Risk of Mortality Circ Cardiovasc Imaging. 2016;9:e003528. DOI: 10.1161/CIRCIMAGING.115.003528. DIABETICS ~5 Years Re-Check CAC for ‘non-Diabetics’: 1. Who will no longer be zero? 2. Who now has risky Athero burden? 3. Which of these guys have now become diabetic ?? Re-Check CAC for Diabetics: 1. Many of them will no longer be zero 2. their Athero Burden could be approaching cliff ! 3. Plaque Rupture & MI’s will begin to ramp !
  • 46. Warranty Periods Explained… NON- DIABETICS: warranty for ~15 years… NO WARRANTY FOR ANYONE HERE !!! DIABETICS NON- DIABETICS NON- DIABETICS DIABETICS Absence of Coronary Artery Calcium Identifies Asymptomatic Diabetic Individuals at Low Near-Term But Not Long-Term Risk of Mortality Circ Cardiovasc Imaging. 2016;9:e003528. DOI: 10.1161/CIRCIMAGING.115.003528. DIABETICS ~5 Years Re-Check CAC for ‘non-Diabetics’: 1. Who will no longer be zero? 2. Who now has risky Athero burden? 3. Which of these guys have now become diabetic ?? Re-Check CAC for Diabetics: 1. Many of them will no longer be zero 2. their Athero Burden could be approaching cliff ! 3. Plaque Rupture & MI’s will begin to ramp !
  • 47. Warranty Periods Explained… NON- DIABETICS: warranty for ~15 years… DIABETICS NON- DIABETICS NO WARRANTY FOR ANYONE HERE !!! NON- DIABETICS DIABETICS DIABETICS ~5 Years Re-Check CAC for ‘non-Diabetics’: 1. Who will no longer be zero? 2. Who now has risky Athero burden? 3. Which of these guys have now become diabetic ?? Absence of Coronary Artery Calcium Identifies Asymptomatic Diabetic Individuals at Low Near-Term But Not Long-Term Risk of Mortality Circ Cardiovasc Imaging. 2016;9:e003528. DOI: 10.1161/CIRCIMAGING.115.003528. Re-Check CAC for Diabetics: 1. Many of them will no longer be zero 2. their Athero Burden could be approaching cliff ! 3. Plaque Rupture & MI’s will begin to ramp !
  • 48. Warranty Periods Explained… NON- DIABETICS: warranty for ~15 years… NON- DIABETICS DIABETICS DIABETICS NON- DIABETICS NO WARRANTY FOR ANYONE HERE !!! DIABETICS ~5 Years Re-Check CAC for ‘non-Diabetics’: 1. Who will no longer be zero? 2. Who now has risky Athero burden? 3. Which of these guys have now become diabetic ?? Absence of Coronary Artery Calcium Identifies Asymptomatic Diabetic Individuals at Low Near-Term But Not Long-Term Risk of Mortality Circ Cardiovasc Imaging. 2016;9:e003528. DOI: 10.1161/CIRCIMAGING.115.003528. Re-Check CAC for Diabetics: 1. Many of them will no longer be zero 2. their Athero Burden could be approaching cliff ! 3. Plaque Rupture & MI’s will begin to ramp !
  • 49. Warranty Periods Explained… NON- DIABETICS: warranty for ~15 years… NON- DIABETICS DIABETICS DIABETICS NON- DIABETICS NO WARRANTY FOR ANYONE HERE !!! DIABETICS ~5 Years Re-Check CAC for ‘non-Diabetics’: 1. Who will no longer be zero? 2. Who now has risky Athero burden? 3. Which of these guys have now become diabetic ?? Absence of Coronary Artery Calcium Identifies Asymptomatic Diabetic Individuals at Low Near-Term But Not Long-Term Risk of Mortality Circ Cardiovasc Imaging. 2016;9:e003528. DOI: 10.1161/CIRCIMAGING.115.003528. Re-Check CAC for Diabetics: 1. Many of them will no longer be zero 2. their Athero Burden could be approaching cliff ! 3. Plaque Rupture & MI’s will begin to ramp !
  • 56. Middle- aged? CAC The Ultimate Decider Trig/HDL ratio PP Insulin Level PP Glucose / A1c GGT / Ferritin Blood Pressure Homocysteine + CAC 5-7 years… sdLDL, ApoB/ApoA1 Middle-Risk? Etc. etc. Adiponectin
  • 57. Middle- aged? CAC The Ultimate Decider Trig/HDL ratio PP Insulin Level PP Glucose / A1c GGT / Ferritin Blood Pressure Homocysteine + CAC 5-7 years… sdLDL, ApoB/ApoA1 Middle-Risk? Etc. etc. Adiponectin
  • 58. Middle- aged? CAC The Ultimate Decider Trig/HDL ratio PP Insulin Level PP Glucose / A1c GGT / Ferritin Blood Pressure Homocysteine + CAC 5-7 years… sdLDL, ApoB/ApoA1 Middle-Risk? Etc. etc. Adiponectin +
  • 59. Middle- aged? CAC The Ultimate Decider Trig/HDL ratio PP Insulin Level PP Glucose / A1c GGT / Ferritin Blood Pressure Homocysteine + CAC 5-7 years… sdLDL, ApoB/ApoA1 Middle-Risk? Etc. etc. Adiponectin +
  • 60. Middle- aged? CAC The Ultimate Decider Trig/HDL ratio PP Insulin Level PP Glucose / A1c GGT / Ferritin Blood Pressure Homocysteine + CAC 5-7 years… sdLDL, ApoB/ApoA1 Middle-Risk? Etc. etc. Adiponectin + CAC ~2yrs
  • 61. A Recent Irish Example…
  • 62. A Recent Irish Example… 44 y.o. Engineer. 3 children. Concerned. * Brother quadruple bypass at 52 * Cousin died of Heart Attack at 50 * Other nasty family history… Noel
  • 63. A Recent Irish Example… 44 y.o. Engineer. 3 children. Concerned. * Brother quadruple bypass at 52 * Cousin died of Heart Attack at 50 * Other nasty family history… * Cholesterol Good * Other Bloods Good * All Good – no worries! Noel
  • 64. A Recent Irish Example… 44 y.o. Engineer. 3 children. Concerned. * Brother quadruple bypass at 52 * Cousin died of Heart Attack at 50 * Other nasty family history… * Cholesterol Good * Other Bloods Good * All Good – no worries! * Stress Test Good * Echocardiogram Good * All Good – no worries! Noel
  • 65. A Recent Irish Example… 44 y.o. Engineer. 3 children. Concerned. * Brother quadruple bypass at 52 * Cousin died of Heart Attack at 50 * Other nasty family history… * Cholesterol Good * Other Bloods Good * All Good – no worries! * Stress Test Good * Echocardiogram Good * All Good – no worries! Our engineer demands a… Calcium Scan Noel
  • 66. A Recent Irish Example… 44 y.o. Engineer. 3 children. Concerned. * Brother quadruple bypass at 52 * Cousin died of Heart Attack at 50 * Other nasty family history… * Cholesterol Good * Other Bloods Good * All Good – no worries! * Stress Test Good * Echocardiogram Good * All Good – no worries! * CAC=25. Diffuse Calcification throughout coronary vessels * It’s NOT All Good. Our engineer demands a… Calcium Scan * It’s NOT “No Worries”. Noel
  • 67. A Recent Irish Example… 44 y.o. Engineer. 3 children. Concerned. * Brother quadruple bypass at 52 * Cousin died of Heart Attack at 50 * Other nasty family history… * Cholesterol Good * Other Bloods Good * All Good – no worries! * Stress Test Good * Echocardiogram Good * All Good – no worries! * CAC=25. Diffuse Calcification throughout coronary vessels * It’s NOT All Good. Our engineer demands a… Calcium Scan * His Framingham Risk was 5% * CAC = 25 means arteries of * His real (MESA) risk is >30% a 64 year old. (+/- 2 years) * It’s NOT “No Worries”. Noel
  • 68. A Recent Irish Example… 44 y.o. Engineer. 3 children. Concerned. * Brother quadruple bypass at 52 * Cousin died of Heart Attack at 50 * Other nasty family history… * Cholesterol Good * Other Bloods Good * All Good – no worries! * Stress Test Good * Echocardiogram Good * All Good – no worries! * CAC=25. Diffuse Calcification throughout coronary vessels * It’s NOT All Good. Our engineer demands a… Calcium Scan * His Framingham Risk was 5% * CAC = 25 means arteries of * His real (MESA) risk is >30% a 64 year old. (+/- 2 years) * It’s NOT “No Worries”. “I’m all over it Ivor… I’m all over it” Noel

Editor's Notes

  1. * Explain CT Image briefly Reiterate that hyperinsulinemia causes the inflammation and damage to the arteries Stress that the disease process recruits calcium to ‘shore up’ the damage that’s occurring !!!
  2. Reproducible and Quantifiable Budoff et al. [5] showed CAC to be an independent predictor of mortality after controlling for age, gender, ethnicity, and cardiac risk factors (model chi-square = 2.017, ), in a registry of 25,253 asymptomatic individuals. CAC was shown to have significant incremental value compared with risk factors resulting in a higher concordance index (0.81 versus 0.61; ). Risk-adjusted relative risk ratios for CAC scores 11 to 100, 101 to 299, 300 to 399, 400 to 699, 700 to 999, and >1000 were 2.2-, 4.5-, 6.4-, 9.2-, 10.4-, and 12.5-fold when compared with CAC score 0, respectively ().
  3. Reproducible and Quantifiable Budoff et al. [5] showed CAC to be an independent predictor of mortality after controlling for age, gender, ethnicity, and cardiac risk factors (model chi-square = 2.017, ), in a registry of 25,253 asymptomatic individuals. CAC was shown to have significant incremental value compared with risk factors resulting in a higher concordance index (0.81 versus 0.61; ). Risk-adjusted relative risk ratios for CAC scores 11 to 100, 101 to 299, 300 to 399, 400 to 699, 700 to 999, and >1000 were 2.2-, 4.5-, 6.4-, 9.2-, 10.4-, and 12.5-fold when compared with CAC score 0, respectively ().
  4. Reproducible and Quantifiable Budoff et al. [5] showed CAC to be an independent predictor of mortality after controlling for age, gender, ethnicity, and cardiac risk factors (model chi-square = 2.017, ), in a registry of 25,253 asymptomatic individuals. CAC was shown to have significant incremental value compared with risk factors resulting in a higher concordance index (0.81 versus 0.61; ). Risk-adjusted relative risk ratios for CAC scores 11 to 100, 101 to 299, 300 to 399, 400 to 699, 700 to 999, and >1000 were 2.2-, 4.5-, 6.4-, 9.2-, 10.4-, and 12.5-fold when compared with CAC score 0, respectively ().
  5. Reproducible and Quantifiable Budoff et al. [5] showed CAC to be an independent predictor of mortality after controlling for age, gender, ethnicity, and cardiac risk factors (model chi-square = 2.017, ), in a registry of 25,253 asymptomatic individuals. CAC was shown to have significant incremental value compared with risk factors resulting in a higher concordance index (0.81 versus 0.61; ). Risk-adjusted relative risk ratios for CAC scores 11 to 100, 101 to 299, 300 to 399, 400 to 699, 700 to 999, and >1000 were 2.2-, 4.5-, 6.4-, 9.2-, 10.4-, and 12.5-fold when compared with CAC score 0, respectively ().
  6. Reproducible and Quantifiable Budoff et al. [5] showed CAC to be an independent predictor of mortality after controlling for age, gender, ethnicity, and cardiac risk factors (model chi-square = 2.017, ), in a registry of 25,253 asymptomatic individuals. CAC was shown to have significant incremental value compared with risk factors resulting in a higher concordance index (0.81 versus 0.61; ). Risk-adjusted relative risk ratios for CAC scores 11 to 100, 101 to 299, 300 to 399, 400 to 699, 700 to 999, and >1000 were 2.2-, 4.5-, 6.4-, 9.2-, 10.4-, and 12.5-fold when compared with CAC score 0, respectively ().
  7. Reproducible and Quantifiable Budoff et al. [5] showed CAC to be an independent predictor of mortality after controlling for age, gender, ethnicity, and cardiac risk factors (model chi-square = 2.017, ), in a registry of 25,253 asymptomatic individuals. CAC was shown to have significant incremental value compared with risk factors resulting in a higher concordance index (0.81 versus 0.61; ). Risk-adjusted relative risk ratios for CAC scores 11 to 100, 101 to 299, 300 to 399, 400 to 699, 700 to 999, and >1000 were 2.2-, 4.5-, 6.4-, 9.2-, 10.4-, and 12.5-fold when compared with CAC score 0, respectively ().
  8. “The Relationship of Coronary Artery Calcium To Coronary Heart Disease Events is Similar in Young and Elderly Participants in The Multi-Ethnic Study of Atherosclerosis”
  9. Pic David How he reacted contrast with say nick NOW HIS LEADERSHIP TO SAVE We’re talking to the 30% who would want to know and save themselves No point going after eejits or the easily fooled by eminence guys