De-risking primary prevention: role of imaging

Abstract

Atherosclerotic cardiovascular disease (ASCVD) is a common disease among the general population, and includes four major areas: (1) coronary heart disease (CHD), manifested by stable angina, unstable angina, myocardial infarction (MI), heart failure, and coronary death; (2) cerebrovascular disease, manifested by transient ischemia attack and stroke; (3) peripheral vascular disease, manifested by claudication and critical limb ischemia; and (4) aortic atherosclerosis and aortic aneurysm (thoracic and abdominal). CHD remains the leading cause of death for both men and women in the United States. So, it is imperative to identify people at risk of CHD and provide appropriate medical treatment or intervention to prevent serious complications and outcomes including sudden cardiac death. Coronary artery calcification (CAC) is a marker of subclinical coronary artery disease. Therefore, coronary artery calcium score is an important screening method for Coronary artery disease (CAD). In this article, we performed a comprehensive review of current literatures and studies assessing the prognostic value of CAC for future cardiovascular disease (CVD) events. We searched PubMed, MEDLINE, Google Scholar, and Cochrane library. We also reviewed the 2018 American College of Cardiology (ACC)/American Heart Association (AHA) guideline on the assessment of CVD risk. A CAC score of zero corresponds to very low CVD event rates (∼1% per year) and hence a potent negative risk marker. This has been referred to as the ‘power of zero’ and affords the lowest risk of any method of risk calculation. It is now indicated in the 2018 ACC/AHA Cholesterol guidelines to be used to avoid statins for 5–10 years after a score of zero, and then re-assess the patient.

Novel wine in an old bottle: Preventive and therapeutic potentials of andrographolide in atherosclerotic cardiovascular diseases

“…ASCVD is common in the general population and includes four main subtypes: (1) CHD, which manifests as myocardial ischemia and myocardial infarction (MI); (2) cerebrovascular diseases, which manifest as transient ischaemic attacks and strokes; (3) PAD, which manifests as claudication and severe limb ischemia; and (4) aortic atherosclerosis and aortic aneurysms [ 32 , 33 ]. Despite recent advances in preventive medicine, the risk of recurrence of ASCVD, a consequence of the enormous burden of atherosclerotic plaques, remains high.…”

Coronary Artery Calcification and One-Year Cardiovascular Disease Incidence in the 75-and-Older Population: The ARIC Study

“…In this context, we would like to acknowledge that identifying a low-risk group may have potential value in older adults (ie, the concept of de-risking) since polypharmacy is a concern in this population. 3 Also, it is worth recognizing the growing interest in potentially using nongated CT scans, conducted for other clinical indications (eg, lung cancer screening), to assess CAC. 4 Although nongated CT scans cannot replace gated CT scans for accurate CAC quantification, there would be a number of older patients with potential of obtaining CAC information without additional CT scans.…”