All-cause and cause-specific mortality in individuals with zero and minimal coronary artery calcium: A long-term, competing risk analysis in the Coronary Artery Calcium Consortium

Blaha, Michael J.; Cainzos‐Achirica, Miguel; Dardari, Zeina; Blankstein, Ron; Shaw, Leslee J.; Rozanski, Alan; Rumberger, John A.; Dzaye, Omar; Michos, Erin D.; Berman, Daniel S.; Budoff, Matthew J.; Miedema, Michael D.; Blumenthal, Roger S.; Nasir, Khurram

doi:10.1016/j.atherosclerosis.2019.11.008

Cited by 62 publications

(57 citation statements)

References 27 publications

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“…The absence of CAC identified people with a low risk over 12 years of follow-up, with most deaths being non-CVD in nature, regardless of risk factor burden. Very recently, another study of the CAC Consortium cohort has been published [30]. The long-term associations between no or minimal CAC and cause-specific mortality are currently unknown.…”

Section: Long-term Clinical Utility Of Cac Scoresmentioning

confidence: 99%

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Recent Updates on Vascular Complications in Patients with Type 2 Diabetes Mellitus

Jung

Mok

2020

Endocrinol Metab

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It is well known that patients with type 2 diabetes mellitus (T2DM) are at an increased risk of morbidity and mortality from atherosclerotic cardiovascular (CV) complications. Previously, the concept that diabetes mellitus (DM) is a "coronary artery disease (CAD) risk equivalent" was widely accepted, implying that all DM patients should receive intensive management. However, considerable evidence exist for wide heterogeneity in the risk of CV events among T2DM patients and the concept of a "CAD risk equivalent" has changed. Recent guidelines recommend further CV risk stratification in T2DM patients, with treatment tailored to the risk level. Although imaging modalities for atherosclerotic cardiovascular disease (ASCVD) have been used to improve risk prediction, there is currently no evidence that imaging-oriented therapy improves clinical outcomes. Therefore, controversy remains whether we should screen for CVD in asymptomatic T2DM. The coexistence of T2DM and heart failure (HF) is common. Based on recent CV outcome trials, sodium glucose cotransporter-2 inhibitors and glucagon like peptide-1 receptor agonists are recommended who have established ASCVD, indicators of high risk, or HF because of their demonstrated benefits for CVD. These circumstances have led to an increasing emphasis on ASCVD and HF in T2DM patients. In this review, we examine the literature published within the last 5 years on the risk assessment of CVD in asymptomatic T2DM patients. In particular, we review recent guidelines regarding screening for CVD and research focusing on the role of coronary artery calcium, coronary computed tomography angiography, and carotid intima-media thickness in asymptomatic T2DM patients.

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Section: Long-term Clinical Utility Of Cac Scoresmentioning

confidence: 99%

“…Very recently, another study of the CAC Consortium cohort has been published [ 30 ]. The long-term associations between no or minimal CAC and cause-specific mortality are currently unknown.…”

Section: Assessment Of Subclinical Atherosclerosismentioning

confidence: 99%

Recent Updates on Vascular Complications in Patients with Type 2 Diabetes Mellitus

Jung

Mok

2020

Endocrinol Metab

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“…The causes of the association remain to be determined, how much this may be explained by gene and environment interactions needs to be determined [17,18]. More data are still needed to expand the power of zero out of the vessels, but results of this study [1] and MESA [15] are, indeed, promising.…”

mentioning

confidence: 83%

“…In the study by Blaha et al [1], patients without CAC had lower prevalence of smoking and diabetes, two conditions associated with cancer overall [14]. However, the absence of CAC was associated with lower rates of total and cancer mortality even in individuals with these conditions.…”

mentioning

confidence: 93%

“…In this issue of Atherosclerosis, Blaha and colleagues show that middle age individuals (n = 66,363, mean age 54 years, 33% women, 89% non-Hispanic Whites), with no coronary artery calcification (CAC, CAC scores = zero, found in 45% of study population) or low CAC (scores 1-10, found in 12% of population) followed by a mean of 12 years in the CAC consortium study, have very-low rates of cardiovascular or total mortality [1]. CAC presence, especially scores > 10 units, denoted increased relative and absolute risks of coronary heart disease, cardiovascular and all cause deaths independent of age.…”

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confidence: 99%

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Absence of coronary artery calcification and low rates not only of coronary and cardiovascular mortality: Can the power of zero be expanded beyond the vessels?

Santos

2020

Atherosclerosis

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Quantitative analysis of small coronary artery calcium detectability with an accurate simulation and validation on a clinical CT scanner

Severance,

Pack,

Contijoch

et al. 2023

Medical Physics

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BackgroundThe absence of coronary artery calcium (CAC) measured via CT is associated with very favorable prognosis, and current guidelines recommend low‐density lipoprotein cholesterol (LDL‐c) lowering therapy for individuals with any CAC. This motivates early detection of small granules of CAC; however, calcium scan sensitivity for detecting very low levels of calcium has not been quantified.PurposeIn this work, the size limit of detectability of small calcium hydroxyapatite (CaHA) granules with clinical CAC scanning was assessed using validated simulations.MethodsCT projections of digital 3D mathematical phantoms containing small CaHA granules were simulated analytically; images were reconstructed using a filter designed to reproduce the point spread function of a specific commercial scanner, and a relationship of HU number versus diameter was derived. These simulation results were validated with experimental measurements of HU versus diameter from phantoms containing small granules of CaHA on a GE Revolution CT scanner in the clinic; ground truth measurements of the CaHA granule diameters were obtained using a Zeiss Xradia 510 Versa high‐resolution 3D micro‐CT imaging system. Using experimental measurements on the clinical CT scanner, detectability was quantified with a detectability index (d’) using a non‐prewhitened matched filter. The effect of changes to reconstruction slice thickness and reconstruction kernel on granule detectability was evaluated.ResultsUnder typical clinical calcium scanning and reconstruction conditions, the minimum detectable diameter of a simulated spherical calcium granule with a clinically relevant CaHA density was 0.76 mm. The minimum detectable volume was 2.4 times smaller on images reconstructed at a slice thickness of 0.625 mm compared to 2.5 mm. The detectability index d’ increased by a factor of 1.7 when images were reconstructed with 0.625 mm slices compared to 2.5 mm slices. d’ did not change when images were reconstructed with the high‐resolution BONE filter compared to the less sharp STANDARD resolution filter on the GE Revolution CT.ConclusionsWe have quantified detectability versus size of small calcium granules at the resolution limit of a widely available clinical CT scanner. Detectability increased significantly with reduced slice thickness and did not change with a sharper reconstruction kernel. The simulation can be used to calculate the trade‐off between dose and CAC detectability. Keywords: computed tomography, coronary artery calcium, CAC, cardiac imaging

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All-cause and cause-specific mortality in individuals with zero and minimal coronary artery calcium: A long-term, competing risk analysis in the Coronary Artery Calcium Consortium

Cited by 62 publications

References 27 publications

Recent Updates on Vascular Complications in Patients with Type 2 Diabetes Mellitus

Recent Updates on Vascular Complications in Patients with Type 2 Diabetes Mellitus

Absence of coronary artery calcification and low rates not only of coronary and cardiovascular mortality: Can the power of zero be expanded beyond the vessels?

Quantitative analysis of small coronary artery calcium detectability with an accurate simulation and validation on a clinical CT scanner

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