The Implication of Coronary Artery Calcium Testing for Cardiovascular Disease Prevention and Diabetes

Abstract

Over the last two decades coronary artery calcium (CAC) scanning has emerged as a quick, safe, and inexpensive method to detect the presence of coronary atherosclerosis. Data from multiple studies has shown that compared to individuals who do not have any coronary calcifications, those with severe calcifications (i.e., CAC score >300) have a 10-fold increase in their risk of coronary heart disease events and cardiovascular disease. Conversely, those that have a CAC of 0 have a very low event rate (~0.1%/year), with data that now extends to 15 years in some studies. Thus, the most notable implication of identifying CAC in individuals who do not have known cardiovascular disease is that it allows targeting of more aggressive therapies to those who have the highest risk of having future events. Such identification of risk is especially important for individuals who are not on any therapies for coronary heart disease, or when intensification of treatment is being considered but has an uncertain role. This review will highlight some of the recent data on CAC testing, while focusing on the implications of those findings on patient management. The evolving role of CAC in patients with diabetes will also be highlighted.

Increased risk for development of coronary artery calcification in subjects with non-alcoholic fatty liver disease and systemic inflammation

“…Previous studies have shown that NAFLD is independently associated with the prevalence of coronary artery calcification (CAC) [11–16]. On the other hand, other studies have reported conflicting results, arguing that the association of NAFLD and CAC is an obesity-related epiphenomenon [17].…”

Being Metabolically Healthy, the Most Responsible Factor for Vascular Health

“…Coronary artery calcification (CAC) is considered as a non-invasive, convenient, and accurate surrogate marker for the prediction of cardiovascular burden and CVD event from the results of many famous cohort studies [ 27 ]. In KSHS, around 10% of the participants perform coronary artery calcium score (CACS) test every year.…”

Diabetes, subclinical atherosclerosis and multiple cardiovascular risk factors in hard-to-reach asymptomatic patients

“…Coronary artery calcium (CAC) is a measure of subclinical atherosclerosis and has been validated as a predictor of cardiovascular events in asymptomatic patients, including those with diabetes. [17][18][19] Studies have shown that asymptomatic patients with diabetes have increased prevalence and progression of CAC and a higher incidence of CVD as absolute values increase. 19 Both cross-sectional 17 and longitudinal 20,21 studies have found that CAC scores were higher in men and women with diabetes across all age groups than those without diabetes and that CAC correlates with an increase in mortality for patients with diabetes.…”

“…[17][18][19] Studies have shown that asymptomatic patients with diabetes have increased prevalence and progression of CAC and a higher incidence of CVD as absolute values increase. 19 Both cross-sectional 17 and longitudinal 20,21 studies have found that CAC scores were higher in men and women with diabetes across all age groups than those without diabetes and that CAC correlates with an increase in mortality for patients with diabetes. As such, it is reasonable to infer that using screening tools, such as CAC to identify subclinical atherosclerosis in regions with a high burden of diabetes, such as Central Appalachia, 13 may have positive health benefits.…”