Implications of coronary artery calcium testing on risk stratification for lipid-lowering therapy according to the 2016 European Society of Cardiology recommendations: The MESA study

Abstract

The absence of coronary artery calcium is associated with a low incidence of cardiovascular mortality or coronary heart disease events even in individuals in whom lipid-lowering therapy is recommended. A significant proportion of individuals deemed to be candidates for lipid-lowering therapy might be reclassified to a lower risk group with the use of coronary artery calcium.

Imaging subclinical atherosclerosis in cardiovascular risk stratification

“…In the Multi-Ethnic Study of Atherosclerosis (MESA), 31% of subjects in whom lipid-lowering therapy was recommended upfront, according to the 2016 European Society of Cardiology recommendations, had CAC score ¼ 0. 3 However, given the high sensitivity of atherosclerotic imaging techniques, they also identify the presence of atherosclerotic lesions in a certain portion of subjects considered to be at low risk. In the Progression Early Subclinical Atherosclerosis study, 4 58% of the middleaged asymptomatic participants at low cardiovascular risk as estimated by SCORE chart had subclinical atherosclerosis in at least one vascular district and 9% had generalized atherosclerosis (in at least four different districts).…”

Editor’s Presentation Benefit of healthy lifestyle on cardiovascular risk factor control: Focus on body weight, exercise and sleep quality

“…A calcium score greater than 300 accurately identified subjects at high risk for future coronary heart disease events, with a hazard ratio of nearly 10. 7 Interesting data supporting new approaches to improve subjects' education toward a healthy lifestyle is here presented based on a sub-analysis from the Dutch Risk Or Benefit IN Screening for CArdiovascular disease (ROBINSCA) trial. The ROBINSCA trial is a large population-based randomized controlled screening trial designed to investigate the difference between the traditional assessment of cardiovascular disease risk, by means of the SCORE risk table, and an evaluation based on coronary artery calcification score performed by computed tomography scanning.…”

Early cardiovascular structural and functional abnormalities as a guide to future morbid events

“…6 Both imaging techniques provide information that can improve the algorithms based on traditional risk factors in predicting clinical cardiovascular outcomes. 6 For example, Bittencourt et al 7 recently demonstrated in the MESA study that the absence of coronary artery calcium is associated with a low incidence of cardiovascular events, even in individuals in whom lipid-lowering therapy is recommended based on the SCORE model. However, imaging techniques, as well as other tests for measuring arterial changes, are recommended for reclassification purposes only to refine the cardiovascular risk estimates given by the risk calculators.…”