Atherosclerotic Plaque in Patients with Zero Calcium Score at Coronary Computed Tomography Angiography

Abstract

BackgroundIn view of the high mortality for cardiovascular diseases, it has become necessary to stratify the main risk factors and to choose the correct diagnostic modality. Studies have demonstrated that a zero calcium score (CS) is characteristic of a low risk for cardiovascular events. However, the prevalence of individuals with coronary atherosclerotic plaques and zero CS is conflicting in the specialized literature.ObjectiveTo evaluate the frequency of patients with coronary atherosclerotic plaques, their degree of obstruction and associated factors in patients with zero CS and indication for coronary computed tomography angiography (CCTA).MethodsThis is a cross-sectional, prospective study with 367 volunteers with zero CS at CCTA in four diagnostic imaging centers in the period from 2011 to 2016. A significance level of 5% and 95% confidence interval were adopted.ResultsThe frequency of atherosclerotic plaque in the coronary arteries in 367 patients with zero CS was 9.3% (34 individuals). In this subgroup, mean age was 52 ± 10 years, 18 (52.9%) were women and 16 (47%) had significant coronary obstructions (> 50%), with involvement of two or more segments in 4 (25%) patients. The frequency of non-obese individuals (90.6% vs 73.9%, p = 0.037) and alcohol drinkers (55.9% vs 34.8%, p = 0.015) was significantly higher in patients with atherosclerotic plaques, with an odds ratio of 3.4 for each of this variable.ConclusionsThe frequency of atherosclerotic plaque with zero CS was relatively high, indicating that the absence of calcification does not exclude the presence of plaques, many of which obstructive, especially in non-obese subjects and alcohol drinkers.

Causal Relationship of Coronary Artery Calcium on Myocardial Infarction and Preventive Effect of Antiplatelet Therapy

“…Patients who have a CACS of 0 or < 100, or non-significant coronary stenosis, still have a chance of having a silent non-calcified plaque or progression of an atherosclerotic plaque which later may result in symptomatic CAD or MI ( 45 ). A recent study report stated that the frequency of non-calcified atherosclerotic plaques in the coronary arteries of patients with CACSs of zero was 9.3% ( 46 ). Such individuals who develop CVD events have been shown to have a higher prevalence of potentially modifiable ASCVD risk factors, such as DM and smoking.…”

A linked mixture model of coronary atherosclerosis

“…More generally, although the simulation studies presented here cover a broad range of realistic epidemiological scenarios, they are strictly limited to the context of the generative model described by Equations 1 and 2. The true process of CAC onset and progression is necessarily more complex, and is only part of the larger process of coronary atherosclerosis, which can be seen as beginning with arterial lesions, and progress to stenosis and vascular occlusion even in the absence of CAC [3,[57][58][59]. Incorporating more physiological details, such as the process of soft plaque accumulation prior to calcification, plaque density and stability [60] or the site-specific formation of individual calcified plaques [20], can potentially lead to further modelling innovations, and consequently greater improvements in estimation accuracy.…”

Ten things to know about ten imaging studies: A preventive cardiology perspective (“ASPC top ten imaging”)

“…[ 58 , 70 , 71 , 72 ] Given that CAC scores are unlikely to regress, CAC scores do not track response to cardiovascular preventive therapy (i.e., response to statins). While alcohol drinkers in general may have increased frequency of atherosclerotic plaque in the coronary arteries despite reduced or zero CAC scores, [ 73 , 74 ] heavy consumption of hard liquor may sometimes increase CAC scores. [ 75 , 76 ] Individuals with a negative CAC score of potential unclear clinical significance include younger individuals who may have non-calcified atherosclerosis, patients with microvascular dysfunction, such as some women (and men) with non-obstructive ischemic heart disease (as may be assessed by PET).…”

“…[ 58 , 70 , 71 , 72 ] Given that CAC scores are unlikely to regress, CAC scores do not track response to cardiovascular preventive therapy (i.e., response to statins). While alcohol drinkers in general may have increased frequency of atherosclerotic plaque in the coronary arteries despite reduced or zero CAC scores, [ 73 , 74 ] heavy consumption of hard liquor may sometimes increase CAC scores. [ 75 , 76 ]…”