Using the Coronary Artery Calcium Score to Predict Coronary Heart Disease Events

Pletcher, Mark J.; Tice, Jeffrey A.; Pignone, Michael; Browner, Warren S.

doi:10.1001/archinte.164.12.1285

Cited by 521 publications

(361 citation statements)

References 42 publications

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“…The relative risks associated with increasing CACSs are at least as large as those associated with established coronary heart disease risk factors in the general population 20. Studies of CACSs in patients with CKD are limited.…”

Section: Discussionmentioning

confidence: 99%

Extracellular Fluid Excess Is Significantly Associated With Coronary Artery Calcification in Patients With Chronic Kidney Disease

Park

Jhee

Yun

et al. 2018

JAHA

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BackgroundExtracellular fluid (ECF) excess is an independent predictor of cardiovascular morbidity in patients undergoing dialysis. This study aimed to investigate the relationship between ECF status, which is affected by renal function, and coronary artery calcification (CAC), which is a marker of cardiovascular disease, in patients with chronic kidney disease (CKD).Methods and ResultsA total of 1741 patients at all stages of pre‐dialysis CKD from the prospective observational cohort of CMERC‐HI (Cardiovascular and Metabolic Disease Etiology Research Center‐High Risk) were analyzed for the association between ECF status and CAC. ECF status was defined as extracellular water‐to‐total body water ratio (ECW/TBW) measured using bioelectrical impedance analysis. ECF excess was defined as ECW/TBW ≥0.390 or ≥0.400 depending on its severity. To define CAC, Agatston coronary artery calcium scores were measured. A total coronary artery calcium score of ≥400 was defined as CAC. The CKD stages were defined according to estimated glomerular filtration rate calculated using the CKD Epidemiology Collaboration equation. ECW/TBW and the proportion of ECF excess increased with progressing CKD stages. Multivariable logistic regression analyses showed that ECW/TBW was independently associated with CAC (per 0.01 increase of ECW/TBW, odds ratio 1.168, 95% confidence interval, 1.079–1.264, P<0.001). The adjusted R 2 for predicting higher coronary artery calcium scores and CAC significantly improved after ECW/TBW was added to conventional factors. This association was further confirmed by net reclassification and integrated discriminant improvements, sensitivity analysis, and subgroup analysis.Conclusions ECF status is independently associated with a high risk of CAC in patients with CKD.Study Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT02003781.

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Section: Discussionmentioning

confidence: 99%

Extracellular Fluid Excess Is Significantly Associated With Coronary Artery Calcification in Patients With Chronic Kidney Disease

Park

Jhee

Yun

et al. 2018

JAHA

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“…We considered a CAC score of 100 as a marker of significant disease based on the recent data, which suggested the similarity of the cardiovascular risk when the CAC score was between 1 to 100, and a progressive increase of this risk when the CAC score was >100 after adjusting for traditional cardiovascular risk factors. 17 A high CAC score is observed in patients with documented CAD 18 and is closely related to age; its prevalence increases dramatically after age 50 years in males. 19 Therefore, the age of 50 years was assigned as the cutoff value in this study.…”

Section: Discussionmentioning

confidence: 99%

Inverse Relation of Total Serum Bilirubin to Coronary Artery Calcification Score Detected by Multidetector Computed Tomography in Males

Zhang

Bian

Kim

et al. 2012

Clinical Cardiology

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Background:Serum total bilirubin has been suggested to have potential anti‐inflammatory and antioxidant effects on the vasculature, acting against plaque formation and subsequent atherosclerosis. This study was designed to assess the association of serum total bilirubin with coronary artery calcification (CAC).Hypothesis:Individuals with higher bilirubin level would be less likely to develop CAC.Methods:Male subjects (N = 3408) underwent evaluation of CAC by cardiac computed tomography. Correlation and logistic regression analysis were performed to assess the relationships between CAC score and other variables.Results:Subjects with a higher CAC score had significantly lower total bilirubin level (P = 0.001). Total bilirubin level was negatively correlated with CAC score (r = −0.052, P = 0.002). A 0.1‐mg/dL increase in bilirubin was associated with a reduced odds ratio (OR) of the risk by 29.2% for a CAC score above 100 (OR: 0.708, 95% confidence interval: 0.542‐0.927, P = 0.012) after adjustment for several variables. Bilirubin was inversely correlated with high‐sensitivity C‐reactive protein (hsCRP) (r = −0.117, P < 0.001).Conclusions:This study demonstrated an independent inverse association between serum total bilirubin and CAC score in males. Low serum bilirubin concentration would be useful as a potential risk factor for CAC in males. Additionally, reduced hsCRP may be 1 of the mechanisms for how bilirubin reduces CAC. © 2012 Wiley Periodicals, Inc.Additional Supporting Information may be found in the online version of this article.Zheng‐Yun Zhang, MD, and Lu‐Qin Bian, MD, contributed equally to this work.The authors have no funding, financial relationships, or conflicts of interest to disclose.

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“…A mixed-models approach to repeated measures (ANCOVA) was used to assess whether changes in BMD measurement over time were related to the presence of baseline AAC, with treatment allocation and potential confounders included in the model. To assess the relationship between BMD and CAC, the cohort was divided into four groups by coronary calcium score (0, 1-100, 100-400, >400), (35) and differences between groups compared by ANOVA. Finally, Kaplan-Meier analysis and Cox proportional hazards modeling were used to assess the contributions of treatment allocation and calcium-related variables on the incidence of cardiovascular events and the effect of baseline AAC on the incidence of fractures.…”

Section: Discussionmentioning

confidence: 99%

“…(28)(29)(30)(31)(32) Similarly, AAC is an independent predictor of fractures in some (31)(32)(33) but not all studies. (34) Coronary artery calcification (CAC), another estab-lished risk factor for cardiovascular disease, (35) also has been associated with low BMD. (36,37) We have recently completed randomized, controlled trials of calcium supplements in a cohort of healthy elderly women and a cohort of healthy middle-aged or older men.…”

Section: Introductionmentioning

confidence: 99%

Relationships between vascular calcification, calcium metabolism, bone density, and fractures

Wang

Bolland

Pelt

et al. 2010

Journal of Bone and Mineral Research

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Factors involved with calcium metabolism, such as serum calcium and phosphate and calcium intake, have been associated with vascular disease in different populations. We investigated whether this association is mediated via increased vascular calcification by assessing relationships between these factors and abdominal aortic calcification (AAC) and coronary artery calcification (CAC). A total of 1471 healthy postmenopausal women participated in a 5-year randomized, placebo-controlled trial of calcium 1 g/day, and 323 healthy middle-aged and older men participated in a 2-year randomized, placebo-controlled trial of calcium 600 or 1200 mg/day. AAC was assessed on vertebral morphometric images at baseline and follow-up. Based on computed tomography, 163 men had CAC assessed, on average, 1.5 years after study completion. In elderly women, AAC was positively related to serum calcium (p < .001), phosphate (p ¼ .04), and the calcium-phosphate product (p ¼ .003), but changes in AAC over time and incidence of cardiovascular events were not related to these variables. In middle-aged men, AAC and CAC were not consistently related to these variables. Neither dietary calcium intake nor calcium supplementation was associated with changes in the prevalence of AAC over time, and calcium supplementation also was not related to CAC scores in men. After adjusting for age, AAC was not associated with low bone mineral density (BMD) at baseline, changes in BMD over time, or fracture incidence. CAC also was not related to baseline BMD. In summary, serum calcium and phosphate are associated with AAC in older women, but dietary calcium intake and calcium supplementation were not associated with changes in AAC over 2 to 5 years. ß

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Using the Coronary Artery Calcium Score to Predict Coronary Heart Disease Events

Abstract: The coronary artery calcium score is an independent predictor of coronary heart disease events.

Cited by 521 publications

References 42 publications

Extracellular Fluid Excess Is Significantly Associated With Coronary Artery Calcification in Patients With Chronic Kidney Disease

Extracellular Fluid Excess Is Significantly Associated With Coronary Artery Calcification in Patients With Chronic Kidney Disease

Inverse Relation of Total Serum Bilirubin to Coronary Artery Calcification Score Detected by Multidetector Computed Tomography in Males

Relationships between vascular calcification, calcium metabolism, bone density, and fractures

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