Coronary Artery Calcium Score and Coronary Heart Disease Events in a Large Cohort of Asymptomatic Men and Women

Abstract

Coronary artery calcium (CAC), a measure of subclinical coronary heart disease (CHD), may be useful in identifying asymptomatic persons at risk of CHD events. The current study included 10,746 adults who were 22-96 years of age, were free of known CHD, and had their CAC quantified by electron-beam tomography at baseline as part of a preventive medical examination at the Cooper Clinic (Dallas, Texas) during 1995-2000. During a mean follow-up of 3.5 years, 81 hard events (CHD death, nonfatal myocardial infarction) and 287 total events (hard events plus coronary revascularization) occurred. Age-adjusted rates (per 1,000 person-years) of hard events were computed according to four CAC categories: no detectable CAC and incremental sex-specific thirds of detectable CAC; these rates were, respectively, 0.4, 1.5, 4.8, and 8.7 (trend p<0.0001) for men and 0.7, 2.3, 3.1, and 6.3 (trend p=0.02) for women. CAC levels also were positively associated with rates of total CHD events for women and men (trend p<0.0001 each). The association between CAC and CHD events remained significant after adjustment for CHD risk factors. CAC was associated with CHD events in persons with no baseline CHD risk factors and in younger (aged <40 years) and older (aged >65 years) study participants. These findings show that CAC is associated with an increased risk of CHD events in asymptomatic women and men.

Progression of coronary artery calcification at the crossroads: sign of progression or stabilization of coronary atherosclerosis?

“…Of note, a large body of evidence renders the absence of calcification a 5-year safety window, with a 0.10% annual risk of events (2,32,(37)(38)(39)(40)(41).…”

Differential Impact of Age, Sex, and Hypertension on Aortic Atherosclerosis

“…1 Autopsy studies have demonstrated that both aortic and coronary atherosclerosis have long subclinical phases [2][3][4][5][6] and in such studies, HTN is associated with greater prevalence and extent of aortic and coronary atherosclerosis. 3,5,6 A growing body of evidence has linked subclinical coronary 7 and aortic 8 -10 atherosclerosis to increased risk for clinically overt CVD, suggesting that early diagnosis and treatment of atherosclerosis in the preclinical stage may reduce CVD sequelae such as myocardial infarction and stroke. However, beyond autopsy studies, our understanding of the relationship between age, sex, and HTN with aortic atherosclerotic burden is incomplete.…”

The role of coronary CT in the assessment and diagnosis of patients with chest pain

“…Nevertheless, some controversy surrounds this score: it does not completely rule out atherosclerosis as non-calcified fibrolipid plaque, such as that shown in Fig 3, can be missed. 18 Calcium score was initially developed for use in asymptomatic patients and although the false-negative rate associated with scores of zero is not known, recent studies have identified significant CAD in acute symptomatic patients with a score of zero. 19,20 Medical therapy should be optimised and imaging considered on a case by case basis -some centres will still proceed to CTCA particularly in young symptomatic patients who are more likely to have non-calcific atherosclerosis.…”