Al−Rifai M, Blaha MJ, Nambi V, et al. - A 16-year follow-up of individuals with CAC=0 (absent coronary artery calcium) revealed that factors such as current cigarette smoking, diabetes mellitus, and hypertension were independently linked with incident atherosclerotic cardiovascular disease (ASCVD) in this population.

• From Multi-Ethnic Study of Atherosclerosis, a total of 3,416 participants with CAC=0 at baseline were analyzed (mean age 58 years; 63% were female, 33% White, 31% Black, 12% Chinese-American, and 24% Hispanic) to determine if conventional cardiovascular risk factors were linked with incident ASCVD events.

• A median follow-up of 16 years recorded 189 ASCVD events of which 91 were CHD, 88 were stroke, and 10 were both CHD and stroke events.

• In participants with CAC=0, the unadjusted event rates of ASCVD were ≤5 per 1000−person−years for the majority of the risk factors with the exception of current cigarette smoking (7.3), diabetes mellitus (8.9), hypertension (5.4), and chronic kidney disease (6.8).

• Post-multivariable-adjustment, current cigarette smoking (hazard ratio: 2.12), diabetes mellitus (1.68), and hypertension (1.57) were the risk factors significantly linked with ASCVD.

• Family history of premature ASCVD could be related to ASCVD risk in females only.