Distribution of Coronary Artery Calcium Scores by Framingham 10-Year Risk Strata in the MESA (Multi-Ethnic Study of Atherosclerosis)

Abstract

Objectives By examining the distribution of CAC across FRS strata in a large, multi-ethnic, community-based sample of men and women, we sought to determine if lower risk persons could potentially benefit from CAC screening. Background The 10-year Framingham risk scores (FRS) and coronary artery calcium (CAC) are predictors of coronary heart disease (CHD). CAC ≥300 is associated with the highest risk for CHD even in low risk (FRS <10%) persons; however expert groups have suggested CAC screening only in intermediate risk (FRS 10–20%) groups. Methods We included 5660 MESA participants. The number needed to screen [number of people that need to be screened to detect one person with CAC above the specified cut-point (NNS)] was used to assess the yield of screening for CAC. CAC prevalence was compared across FRS strata using chi-square tests. Results CAC >0, ≥100 and ≥300 were present in 46.4%, 20.6% and 10.1% of participants, respectively. Prevalence and amount of CAC increased with higher FRS. CAC ≥300 was observed in 1.7% and 4.4% of those with FRS 0–2.5% and 2.6–5%, respectively (NNS =59.7 and 22.7). Likewise, CAC ≥300 was observed in 24% and 30% of those with FRS 15.1–20% and >20%, respectively (NNS =4.2 and 3.3). Trends were similar when stratified by age, gender and race/ethnicity. Conclusions Our study suggests that in very low risk individuals (FRS ≤5%), the yield of screening and probability of identifying persons with clinically significant levels of CAC is low, but becomes greater in low and intermediate risk persons (FRS 5.1–20%).

Quantification of Incomplete Revascularization and its Association With Five-Year Mortality in the Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) Trial Validation of the Residual SYNTAX Score

“…Third, that coronary artery calcification has been linked to adverse all-cause mortality at 10 years, independent of other risk factors. 53,54 Notably, heavy calcification was present in almost two-thirds (64.5%) of subjects with a residual SYNTAX Score >8 (Table 1).…”

Is There a Role for Coronary Artery Calcium Scoring for Management of Asymptomatic Patients at Risk for Coronary Artery Disease?

“…[18][19][20][21] Likewise, young patients and those with 0 or 1 risk factor may have an increased burden of atherosclerosis ( Figure 2).Although there is a direct relationship between predicted FRS and the presence and severity of CAC, the distribution of CAC within FRS groups remains heterogeneous. 22 The national Heart, Lung, and Blood Institute (nHLBI)-funded population-based Multi-ethnic Study of Atherosclerosis (MeSA), which enrolled apparently healthy adults with no known CvD, is an optimal study to observe this heterogeneity. For example, when MeSA participants are stratified by age and risk factor burden, 2 of the most important components of the FRS, a substantial amount of disagreement is noted with the directly measured atherosclerosis burden.…”

An International Atherosclerosis Society Position Paper: Global recommendations for the management of dyslipidemia

“…These modalities can be a useful guide for stroke prevention. There is little doubt that CAC adds predictive power when combined with Framingham risk scoring (Grundy 1999;Greenland et al 2004;Sung et al 2008;Elias-Smale et al 2010;Okwuosa et al 2011;Tota-Maharaj et al 2012;Yeboah et al 2013Youssef et al 2013). …”