Interpretation of the Coronary Artery Calcium Score in Combination With Conventional Cardiovascular Risk Factors

Abstract

Background The coronary artery calcium (CAC) score predicts coronary heart disease (CHD) events, but methods for interpreting the score in combination with conventional CHD risk factors have not been established. Methods and Results We analyzed CAC scores and CHD risk factor measurements from 6757 Black, Chinese, Hispanic and white men and women aged 45–84 years in the Multi-Ethnic Study of Atherosclerosis (MESA). CAC was associated with age, sex, race-ethnicity, and all conventional CHD risk factors. Multivariable models using these factors predicted the presence of CAC (C-statistic = 0.789) and degree of elevation (16% of variation explained), and can be used to update a “pre-test” CHD risk estimate, such as the 10-year Framingham Risk Score, that is based on an individual’s conventional risk factors. In scenarios where a high CAC score is expected, a moderately elevated CAC score of 50 is reassuring (e.g., reducing risk from 10% to 6% in a healthy older white man); but when a low/zero CAC score is expected, even with identical pre-test CHD risk, the same CAC score of 50 may be alarmingly high (e.g., increasing risk from 10% to 20% in a middle-aged black woman with multiple risk factors). Both the magnitude and direction of the shift in risk varied markedly with pre-test CHD risk and with the pattern of risk factors. Conclusions Knowing what CAC score to expect for an individual patient, based on their conventional risk factors, may help clinicians decide when to order a CAC test and how to interpret the results.

Brachial-ankle pulse wave velocity is associated with coronary calcium in young and middle-aged asymptomatic adults: The Kangbuk Samsung Health Study

“…Furthermore, baPWV improved the ability of traditional risk factors (measured using standardized procedures and validated questionnaires) for detecting prevalent CAC. This information may help decide when to order a CAC scan, and aid in the interpretation of the score [23].…”

Extracoronary Thoracic and Coronary Artery Calcifications on Chest CT for Lung Cancer Screening

“…may provide supplementary prognostic information'' compared to CAC. In keeping with this, it has been proposed that ECC may be used as a marker of systemic, noncoronary atherosclerosis (45). Among participants of the MESA study, ECC load has been shown to correlate with insulin resistance (46).…”

Recent Highlights of ATVB

“…29 Because vascular calcification is independently associated with hypertension in epidemiological studies and RANKL is essential for calcification, it is important to understand that RANKL is an activator of the renin-angiotensin system. 7,30 However, infusion of angiotensin II (100 ng/kg per minute) in ovariectomized ApoE −/− mice significantly increased the expression of RANKL and calcification in vivo, whereas administration of angiotensin II receptor blocker (olmesartan, 3 mg/kg per day) decreased the calcification and expression of bone markers, 30 which introduce a molecular feedback between endocrinology pathways and vascular calcification in the pathogenesis of hypertension. Cross-talk between the renin-angiotensin II and RANKL system has been suggested to work in a vicious cycle to promote vascular calcification in atherosclerosis.…”

“…Agatston et al 6 devised a coronary artery calcification (CAC) scoring scheme, and others have shown calcium score to be a better predictor of future events than the Framingham risk index alone. 7 There is also a close relationship between the presence of CAC and atherosclerotic plaque burden, with angiographic studies showing high sensitivity but poor specificity of CAC score for predicting obstructive disease. 8 Physical activity is known to decrease cardiovascular mortality; however, there is no relationship between the extent of coronary calcification as assessed by CT in individuals engaged in moderate exercise.…”