Performing coronary artery calcium (CAC) screening as part of low-dose CT lung cancer screening has been proposed as an efficient strategy to detect people with high cardiovascular risk and improve outcomes of primary prevention. This study aims to investigate whether CAC measured on low-dose CT in a population of former and current heavy smokers is an independent predictor of all-cause mortality and cardiac events.We used a case-cohort study and included 958 subjects 50 years old or older within the screen group of a randomized controlled lung cancer screening trial. We used Cox proportional-hazard models to compute hazard ratios (HRs) adjusted for traditional cardiovascular risk factors to predict all-cause mortality and cardiovascular events.During a median follow-up of 21.5 months, 56 deaths and 127 cardiovascular events occurred. Compared with a CAC score of 0, multivariate-adjusted HRs for all-cause mortality for CAC scores of 1-100, 101-1000, and more than 1000 were 3.00 (95\% CI, 0.61-14.93), 6.13 (95\% CI, 1.35-27.77), and 10.93 (95\% CI, 2.36-50.60), respectively. Multivariate-adjusted HRs for coronary events were 1.38 (95\% CI, 0.39-4.90), 3.04 (95\% CI, 0.95-9.73), and 7.77 (95\% CI, 2.44-24.75), respectively.This study shows that CAC scoring as part of low-dose CT lung cancer screening can be used as an independent predictor of all-cause mortality and cardiovascular events.