Aims: To determine the extent and prognostic significance of coronary artery c alcium in asymptomatic smokers and nonsmokers. Population data are available on the prognostic impact of smoking on atherosclerotic imaging measurements of the carotid and peripheral arteries. Limited data are available on the impact of cig arette smoking on the prognostic value of coronary calcium. Methods and results: A referred patient registry of 10 377 asymptomatic individuals(40%were current smokers) was followed for death from all-causes at 5 years. Univariable and mu ltivariable Cox proportional hazard models were calculated to estimate time to a ll-cause mortality. Cumulative 5-year survival was 96.9 and 98.4%for smokers when compared with non-smokers(P1000(P1000(P1000 was associated with a relative risk ratio that was elevated 8.9-fold(P=0.029). Thus, resulting in an expected reduction in life expectancy of 4.8 years for sm okers400(P< 0.0001). Conclusion: The pro gnostic value of coronary artery calcium scoring was accurate in identifying a h igh-risk cohort of asymptomatic smokers and non-smokers. Young smokers with hi gh-risk calcium scores have a four-to nine-fold increased risk of dying when compared with similarly aged non-smokers. When prospectively applied, evidence of a high-risk calcium score may be useful in educating patients as to their ex pected risk of dying over the next 5 years.
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