ArticleCirculation2021
Very High Coronary Artery Calcium (≥1000) and Association With Cardiovascular Disease Events, Non-Cardiovascular Disease Outcomes, and Mortality: Results From MESA.
Article in Circulation, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 82 papers, 4 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
82 citing papers in PubMed, 4 syntheses or guidelines pooled it, 140 citations in OpenAlex.
- Intracranial Arterial Calcification on Computed Tomography and Risk of Cognitive Impairment or Dementia: A Systematic Review and Meta-Analysis.Cerebrovascular diseases (Basel, Switzerland) · 2026Pooled it
- Guideline
- Rat models for arterial calcification associated with chronic kidney disease: a systematic review and meta-analysis.BMC cardiovascular disorders · 2026Pooled it
- Atherosclerosis after pre-eclampsia: systematic review and meta-analysis.Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology · 2026Pooled it
- Fully automated deep learning powered calcium scoring in patients undergoing myocardial perfusion imaging.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2023Trial
- The clinical performance of ultra-low-dose shoulder CT scans: The assessment on image and physical 3D printing models.PloS one · 2022Trial
- Accuracy of visual estimation of coronary artery calcifications on low-dose CT from oncologic FDG PET/CT.The international journal of cardiovascular imaging · 2026Article
- Dyslipidaemias in cancer patients.European heart journal · 2026Review
- The 2026 ACC/AHA Dyslipidemia Guideline: A Critical and Transatlantic Perspective on Personalized Lipid Management.Life (Basel, Switzerland) · 2026Review
- Single-cell transcriptomics uncovers endothelial progenitor-like remodelling driving human coronary atherosclerosis progression.Nature cell biology · 2026Article
- Masters Athletes With Abnormal Cardiovascular Findings: A Clinical Consensus Statement of the European Association of Preventive Cardiology of the ESC and the American College of Cardiology.Journal of the American College of Cardiology · 2026Article
- Masters athletes with abnormal cardiovascular findings: a clinical consensus statement of the European Association of Preventive Cardiology of the ESC and the American College of Cardiology.European heart journal · 2026Article
- Advanced Multimodality Cardiovascular Imaging in Patients at Very High Cardiovascular Risk Without a Previous Cardiovascular Event: Current Knowledge and Future Perspectives.Journal of cardiovascular development and disease · 2026Review
- Risk prediction and prevention in patients with advanced subclinical atherosclerosis.BMC cardiovascular disorders · 2026Review
- Plasma proteomics and coronary artery calcium score: synergistic, concordant and contrasting predictions of cardiovascular outcomes in The Multi-Ethnic Study of Atherosclerosis.medRxiv : the preprint server for health sciences · 2026Article
- Severity of Intracranial Arterial Calcification on Computed Tomography and Risk of Dementia in Patients With Stroke or Transient Ischemic Attack: A Population-Based Study.Journal of the American Heart Association · 2026Article
- Personalizing prevention for healthy cardiovascular aging: Geriatric cardiology in the 2024-2025 hypertension and dyslipidemia guidelines.American journal of preventive cardiology · 2026Article
- Coronary atherosclerotic burden in patients with embolic stroke of undetermined source.European stroke journal · 2026Article
- Sex-Specific Coronary Artery Calcium Score Thresholds Predictive of Obstructive Coronary Artery Disease: Ready for Prime Time?Journal of the Society for Cardiovascular Angiography & Interventions · 2026Article
- Coronary artery calcium scoring in 2026: strengths, limitations, and optimized clinical use.Frontiers in radiology · 2026Review
22 more citing papers are in PubMed but not listed here.
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Authors and funding
13 authors at 6 institutions in 2 countries.
Funding
Abstract
backgroundThere are limited data on the unique cardiovascular disease (CVD), non-CVD, and mortality risks of primary prevention individuals with very high coronary artery calcium (CAC; ≥1000), especially compared with rates observed in secondary prevention populations.
methodsOur study population consisted of 6814 ethnically diverse individuals 45 to 84 years of age who were free of known CVD from MESA (Multi-Ethnic Study of Atherosclerosis), a prospective, observational, community-based cohort. Mean follow-up time was 13.6±4.4 years. Hazard ratios of CAC ≥1000 were compared with both CAC 0 and CAC 400 to 999 for CVD, non-CVD, and mortality outcomes with the use of Cox proportional hazards regression adjusted for age, sex, and traditional risk factors. Using a sex-adjusted logarithmic model, we calculated event rates in MESA as a function of CAC and compared them with those observed in the placebo group of stable secondary prevention patients in the FOURIER clinical trial (Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk).
resultsCompared with CAC 400 to 999, those with CAC ≥1000 (n=257) had a greater mean number of coronary vessels with CAC (3.4±0.5), greater total area of CAC (586.5±275.2 mm
conclusionsIndividuals with very high CAC (≥1000) are a unique population at substantially higher risk for CVD events, non-CVD outcomes, and mortality than those with lower CAC, with 3-point major adverse cardiovascular event rates similar to those of a stable treated secondary prevention population. Future guidelines should consider a less distinct stratification algorithm between primary and secondary prevention patients in guiding aggressive preventive pharmacotherapy.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.