Coronary artery Calcium predicts Cardiovascular events in participants with a low lifetime risk of Cardiovascular disease: The Multi-Ethnic Study of Atherosclerosis (MESA)

Joshi, Parag H.; Patel, Birju; Blaha, Michael J.; Berry, Jarett D.; Blankstein, Ron; Budoff, Matthew J.; Wong, Nathan D.; Agatston, Arthur S.; Blumenthal, Roger S.; Nasir, Khurram

doi:10.1016/j.atherosclerosis.2016.01.017

Cited by 44 publications

(26 citation statements)

References 25 publications

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“…It is most evident among patients classified at intermediate risk by traditional measures. Across studies, patients with CAC=0 have a very low risk of future events (<0.1%/y risk of CAD) . Conversely, patients with CAC≥100 are at significant risk of CAD with a tenfold increased event rate compared with CAC=0.…”

Section: Coronary Artery Calcium Scoring Versus Coronary Computed Tommentioning

confidence: 99%

Italian Chapter of the International Society of Cardiovascular Ultrasound expert consensus document on coronary computed tomography angiography: overview and new insights

Sozzi

Maiello²,

Pelliccia

et al. 2016

Echocardiography

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Coronary computed tomography angiography is a noninvasive heart imaging test currently undergoing rapid development and advancement. The high resolution of the three-dimensional pictures of the moving heart and great vessels is performed during a coronary computed tomography to identify coronary artery disease and classify patient risk for atherosclerotic cardiovascular disease. The technique provides useful information about the coronary tree and atherosclerotic plaques beyond simple luminal narrowing and plaque type defined by calcium content. This application will improve image-guided prevention, medical therapy, and coronary interventions. The ability to interpret coronary computed tomography images is of utmost importance as we develop personalized medical care to enable therapeutic interventions stratified on the bases of plaque characteristics. This overview provides available data and expert's recommendations in the utilization of coronary computed tomography findings. We focus on the use of coronary computed tomography to detect coronary artery disease and stratify patients at risk, illustrating the implications of this test on patient management. We describe its diagnostic power in identifying patients at higher risk to develop acute coronary syndrome and its prognostic significance. Finally, we highlight the features of the vulnerable plaques imaged by coronary computed tomography angiography.

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Section: Coronary Artery Calcium Scoring Versus Coronary Computed Tommentioning

confidence: 99%

Italian Chapter of the International Society of Cardiovascular Ultrasound expert consensus document on coronary computed tomography angiography: overview and new insights

Sozzi

Maiello²,

Pelliccia

et al. 2016

Echocardiography

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“…At the same burden of CAC, African Americans (AAs) have increased events compared to those of European Ancestry (EA) [32,33]. Notably, increased CAC independently predicts higher risk of events across all age groups [34] including in those at low lifetime risk of CAD based on their other CAD risk factors [35]. …”

Section: Introductionmentioning

confidence: 99%

Genetics of Subclinical Coronary Atherosclerosis

Bielak

Peyser

2018

Curr Genet Med Rep

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Purpose of Review. This review highlights recent findings regarding genetics of coronary artery calcification (CAC), a marker of subclinical atherosclerosis burden, that is a precursor of clinical coronary artery disease. Recent findings. CAC quantity is heritable. Genome wide association studies of common single nucleotide polymorphisms have identified genomic regions explaining ~2.4% of CAC heritability. Low frequency and rare variants explain additional variation in CAC. Evidence suggests that there may be different genetic etiologies for variation in CAC progression than for cross-sectional measures of CAC. Studies integrating multiple -omics data are providing new insights into the pathobiology of subclinical coronary atherosclerosis. Summary. The future is promising for innovative studies utilizing whole genome sequencing data as well as other -omics such as epigenomic modifications of genes and gene expression. These studies may provide multiple sources of data pointing to the same gene or pathway, thus providing greater confidence in findings.

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“…The presence of calcified coronary plaque detected on cardiac computed tomography has been shown to be a strong predictor of future major adverse cardiovascular events among asymptomatic individuals, and it offers incremental risk stratification beyond traditional risk factors and risk scores endorsed by national guidelines (1–3). Coronary artery calcium (CAC) testing offers the potential to promote more aggressive pharmacological and lifestyle therapies among individuals with an elevated CAC score who are thus at increased risk for adverse cardiovascular events (4–6).…”

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confidence: 99%

The Identification of Calcified Coronary Plaque Is Associated With Initiation and Continuation of Pharmacological and Lifestyle Preventive Therapies

Gupta

Lau

Varshney

et al. 2017

JACC: Cardiovascular Imaging

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136

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OBJECTIVES The aim of this study was to assess the odds of initiation or continuation of pharmacological and lifestyle preventive therapies in patients with nonzero versus zero coronary artery calcium (CAC) score detected on cardiac computed tomography. BACKGROUND Detection of calcified coronary plaque could serve as a motivational tool for physicians and patients to intensify preventive therapies. METHODS We searched PubMed, EMBASE (Excerpta Medica database), Web of Science, Cochrane CENTRAL (Cochrane central register of controlled trials), ClinicalTrials.gov, and the International Clinical Trials Registry Platform for studies evaluating the association of CAC scores with downstream pharmacological or lifestyle interventions for prevention of cardiovascular disease. Pooled odds ratios (ORs) of downstream interventions were obtained using the DerSimonian and Laird random effects model. RESULTS After a review of 6,256 citations and 54 full-text papers, 6 studies (11,256 participants, mean follow-up time: 1.6 to 6.0 years) were included. Pooled estimates of the odds of aspirin initiation (OR: 2.6; 95% confidence interval [CI]: 1.8 to 3.8), lipid-lowering medication initiation (OR: 2.9; 95% CI: 1.9 to 4.4), blood pressure–lowering medication initiation (OR: 1.9; 95% CI: 1.6 to 2.3), lipid-lowering medication continuation (OR: 2.3; 95% CI: 1.6 to 3.3), increase in exercise (OR: 1.8; 95% CI: 1.4 to 2.4), and dietary change (OR: 1.9; 95% CI: 1.5 to 2.5) were higher in individuals with nonzero CAC versus zero CAC scores, but not for aspirin or blood pressure–lowering medication continuation. When assessed within individual studies, these findings remained significant after adjustment for baseline patient characteristics and cardiovascular risk factors. CONCLUSIONS This systematic review and meta-analysis suggests that nonzero CAC score, identifying calcified coronary plaque, significantly increases the likelihood of initiation or continuation of pharmacological and lifestyle therapies for the prevention of cardiovascular disease. (J Am Coll Cardiol Img 2017;10:833–42)

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Coronary artery Calcium predicts Cardiovascular events in participants with a low lifetime risk of Cardiovascular disease: The Multi-Ethnic Study of Atherosclerosis (MESA)

Cited by 44 publications

References 25 publications

Italian Chapter of the International Society of Cardiovascular Ultrasound expert consensus document on coronary computed tomography angiography: overview and new insights

Italian Chapter of the International Society of Cardiovascular Ultrasound expert consensus document on coronary computed tomography angiography: overview and new insights

Genetics of Subclinical Coronary Atherosclerosis

The Identification of Calcified Coronary Plaque Is Associated With Initiation and Continuation of Pharmacological and Lifestyle Preventive Therapies

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