Clinical indications for coronary artery calcium scoring in asymptomatic patients: Expert consensus statement from the Society of Cardiovascular Computed Tomography

Hecht, Harvey S.; Blaha, Michael J.; Berman, Daniel S.; Nasir, Khurram; Budoff, Matthew J.; Leipsic, Jonathon; Blankstein, Ron; Narula, Jagat; Rumberger, John A.; Shaw, Leslee J.

doi:10.1016/j.jcct.2017.02.010

Cited by 290 publications

(237 citation statements)

References 126 publications

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“…Indicative coronary artery calcium (CAC) percentiles by score, sex and age* * Adapted from Hecht et al 8 Percentiles determined using the Multi‐Ethnic Study of Atherosclerosis calculator (http://mesa-nhlbi.org/Calcium/input.aspx). …”

Section: Coronary Artery Calcificationmentioning

confidence: 99%

“…Patients with CAC scores of 1–99 have a relative risk about twice that of patients with a score of zero; 8 however, the evidence for pharmacotherapy is weak, as no observational or prospective trial data are available to guide treatment decisions in this group. We recommend a healthy diet and lifestyle for maintaining a low 10‐year risk, unless other clinical factors are present (eg, strong family history of premature infarction at < 50 years of age in a first degree relative; familial hypercholesterolaemia).…”

Section: Recommendationsmentioning

confidence: 99%

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Cardiac Society of Australia and New Zealand position statement executive summary: coronary artery calcium scoring

Hamilton-Craig

Chow

Younger

et al. 2017

Medical Journal of Australia

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Introduction This article summarises the Cardiac Society of Australia and New Zealand position statement on coronary artery calcium (CAC) scoring. CAC scoring is a non-invasive method for quantifying coronary artery calcification using computed tomography. It is a marker of atherosclerotic plaque burden and the strongest independent predictor of future myocardial infarction and mortality. CAC scoring provides incremental risk information beyond traditional risk calculators such as the Framingham Risk Score. Its use for risk stratification is confined to primary prevention of cardiovascular events, and can be considered as individualised coronary risk scoring for intermediate risk patients, allowing reclassification to low or high risk based on the score. Medical practitioners should carefully counsel patients before CAC testing, which should only be undertaken if an alteration in therapy, including embarking on pharmacotherapy, is being considered based on the test result. Main recommendations CAC scoring should primarily be performed on individuals without coronary disease aged 45-75 years (absolute 5-year cardiovascular risk of 10-15%) who are asymptomatic. CAC scoring is also reasonable in lower risk groups (absolute 5-year cardiovascular risk, < 10%) where risk scores traditionally underestimate risk (eg, family history of premature CVD) and in patients with diabetes aged 40-60 years. We recommend aspirin and a high efficacy statin in high risk patients, defined as those with a CAC score ≥ 400, or a CAC score of 100-399 and above the 75th percentile for age and sex. It is reasonable to treat patients with CAC scores ≥ 100 with aspirin and a statin. It is reasonable not to treat asymptomatic patients with a CAC score of zero. Changes in management as a result of this statement Cardiovascular risk is reclassified according to CAC score. High risk patients are treated with a high efficacy statin and aspirin. Very low risk patients (ie, CAC score of zero) do not benefit from treatment.

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Section: Coronary Artery Calcificationmentioning

confidence: 99%

Section: Recommendationsmentioning

confidence: 99%

Cardiac Society of Australia and New Zealand position statement executive summary: coronary artery calcium scoring

Hamilton-Craig

Chow

Younger

et al. 2017

Medical Journal of Australia

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“…Based on the current available evidence and consistent with recent cardiology society guidelines, we recommend CAC scoring over other risk assessment tools including ABI and cIMT for risk stratifying patients with vascular ED who are considered intermediate risk (5%–20% 10-year CVD risk) – consistent with the recent Society of Cardiovascular Computed Tomography (SCCT) guidelines on appropriate use of CAC scoring [36]. CAC can also be used in low risk patients (<5% risk) who have a strong family history of heart disease.…”

Section: Perspective Of the Preventive Cardiologistmentioning

confidence: 82%

Vascular Erectile Dysfunction and Subclinical Cardiovascular Disease

Gowani

Uddin

Mirbolouk

et al. 2017

Curr Sex Health Rep

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Purpose of review We review the recent literature on the hypothesized temporal relationship between subclinical cardiovascular disease (CVD), vascular erectile dysfunction (ED), and clinical CVD. In addition, we combine emerging research with expert consensus guidelines such as The Princeton Consensus III to provide a preventive cardiologist’s perspective toward an ideal approach to evaluating and managing CVD and ED risk in patients. Recent findings Development of ED was found to occur during the progression from subclinical CVD to clinical CVD. A strong association was observed between subclinical CVD as assessed by coronary artery calcium (CAC) and carotid plaque and subsequent ED, providing evidence for the role of subclinical CVD in predicting ED. ED is also identified as a substantial independent risk factor for overt clinical CVD, and ED symptoms may precede CVD symptoms by 2–3 years. Summary Given the body of evidence on the relationship between subclinical CVD, ED, and clinical CVD we recommend that all men with vascular ED should undergo cardiovascular risk assessment. We further recommend using CAC scores for advanced risk assessment in patients at low-intermediate to intermediate risk (5–20% CVD risk), with risk driving subsequent lifestyle and pharmacologic treatment decisions.

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“…CV imaging in FDRs with a family history of premature ASCVD can assess an individual's response to both measured and unmeasured risk factors over the time of exposure as reflected by age. Increased CAC has been reported in FDRs of patients with premature ASCVD, and expert consensus statements have recommended the selective use of CAC scoring in individuals with a family history of premature ASCVD . However, a limitation of CAC scoring is that it does not assess noncalcified plaque, and therefore it may not detect the earlier stages of atherosclerosis.…”

Section: Discussionmentioning

confidence: 99%

The design and rationale of SAVE BC: The Study to Avoid CardioVascular Events in British Columbia

Brunham

Lynch

English

et al. 2018

Clinical Cardiology

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Atherosclerotic cardiovascular disease (ASCVD) is highly heritable, particularly when it occurs at a young age. The screening of individuals with premature ASCVD, although often recommended, is not routinely performed. Strategies to address this gap in care are essential. We designed the Study to Avoid CardioVascular Events in British Columbia (SAVE BC) as a prospective, observational study of individuals with a new diagnosis of very premature ASCVD (defined as age ≤ 50 years in males and age ≤ 55 years in females) and their first-degree relatives (FDRs) and spouses. FDRs and spouses will undergo screening for cardiovascular (CV) risk factors and subclinical ASCVD using a structured screening algorithm. All subjects will be followed longitudinally for ≥10 years. The overall goal of SAVE BC is to evaluate the yield of a structured screening program for identifying individuals at risk of premature ASCVD. The primary objectives of SAVE BC are to identify and follow index cases with very premature ASCVD and their FDRs and to determine the diagnostic yield of a structured screening program for these individuals. We will collect data on CV risk factors, medication use, CV events, and healthcare costs in these individuals. SAVE BC will provide insight regarding approaches to identify individuals at risk for premature ASCVD with implications for prevention and treatment in this population.

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Clinical indications for coronary artery calcium scoring in asymptomatic patients: Expert consensus statement from the Society of Cardiovascular Computed Tomography

Cited by 290 publications

References 126 publications

Cardiac Society of Australia and New Zealand position statement executive summary: coronary artery calcium scoring

Cardiac Society of Australia and New Zealand position statement executive summary: coronary artery calcium scoring

Vascular Erectile Dysfunction and Subclinical Cardiovascular Disease

The design and rationale of SAVE BC: The Study to Avoid CardioVascular Events in British Columbia

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