Coronary artery calcium scoring: an evidence‐based guide for primary care physicians

Cheong, Benjamin; Wilson, James M.; Spann, Steven; Pettigrew, Roderic I.; Preventza, Ourania; Muthupillai, Raja

doi:10.1111/joim.13176

Cited by 37 publications

(32 citation statements)

References 85 publications

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“…A CAC score of 0 is generally considered a very good prognosis. 40 Recent US guidelines state that the CAC score could be used in primary prevention to improve classification of individuals identified by PCE to be at intermediate 10-year risk of atherosclerotic cardiovascular disease; a CAC score of 0 would indicate a lowered risk and therefore not favor treatment with statins, which would otherwise be recommended in this group. 45 However, studies and guidelines have questioned the negative predictive value of 0 CAC because significant atherosclerosis in the absence of CAC is possible.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Subclinical Coronary Artery Atherosclerosis in the General Population

et al. 2021

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Background: Early detection of coronary atherosclerosis using coronary computed tomography angiography (CCTA), in addition to coronary artery calcification (CAC) scoring, may help inform prevention strategies. We used CCTA to determine the prevalence, severity, and characteristics of coronary atherosclerosis and its association with CAC scores in a general population. Methods: We recruited 30 154 randomly invited individuals age 50 to 64 years to SCAPIS (the Swedish Cardiopulmonary Bioimage Study). The study includes individuals without known coronary heart disease (ie, no previous myocardial infarctions or cardiac procedures) and with high-quality results from CCTA and CAC imaging performed using dedicated dual-source CT scanners. Noncontrast images were scored for CAC. CCTA images were visually read and scored for coronary atherosclerosis per segment (defined as no atherosclerosis, 1% to 49% stenosis, or ≥50% stenosis). External validity of prevalence estimates was evaluated using inverse probability for participation weighting and Swedish register data. Results: In total, 25 182 individuals without known coronary heart disease were included (50.6% women). Any CCTA-detected atherosclerosis was found in 42.1%; any significant stenosis (≥50%) in 5.2%; left main, proximal left anterior descending artery, or 3-vessel disease in 1.9%; and any noncalcified plaques in 8.3% of this population. Onset of atherosclerosis was delayed on average by 10 years in women. Atherosclerosis was more prevalent in older individuals and predominantly found in the proximal left anterior descending artery. Prevalence of CCTA-detected atherosclerosis increased with increasing CAC scores. Among those with a CAC score >400, all had atherosclerosis and 45.7% had significant stenosis. In those with 0 CAC, 5.5% had atherosclerosis and 0.4% had significant stenosis. In participants with 0 CAC and intermediate 10-year risk of atherosclerotic cardiovascular disease according to the pooled cohort equation, 9.2% had CCTA-verified atherosclerosis. Prevalence estimates had excellent external validity and changed marginally when adjusted to the age-matched Swedish background population. Conclusions: Using CCTA in a large, random sample of the general population without established disease, we showed that silent coronary atherosclerosis is common in this population. High CAC scores convey a significant probability of substantial stenosis, and 0 CAC does not exclude atherosclerosis, particularly in those at higher baseline risk.

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Section: Discussionmentioning

confidence: 99%

Prevalence of Subclinical Coronary Artery Atherosclerosis in the General Population

et al. 2021

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“…In this scenario, atheromatic calcifications are used by clinicians to establish the risk of cardiovascular events, mainly in coronary plaques. Specifically, a scoring system based on cardiac computed tomography analysis is commonly use in the clinical practice as a well-established marker of coronary plaque burden [ 3 , 5 , 28 , 29 ]. No specific scoring systems have been developed to evaluate the risk associated to the presence of calcium deposits in carotid plaques since the lack of solid and inconvertible data.…”

Section: Discussionmentioning

confidence: 99%

“…Plaques were divided, according to the modified American Heart Association atherosclerosis classification [ 23 , 28 ], into stable and unstable. Unstable plaques were constituted by (a) thrombotic plaques associated with rupture or erosion of the cap; (b) healed plaque with a thrombus in organization; (c) vulnerable plaque or thin-cap fibro-atheroma (TCFA) characterized by a fibrous cap less than 165 µm thick heavily infiltrated by macrophages, CD68 positive (>25 per high magnification field), without plaque rupture.…”

Section: Methodsmentioning

confidence: 99%

The Paradox Effect of Calcification in Carotid Atherosclerosis: Microcalcification Is Correlated with Plaque Instability

Montanaro

Scimeca

Anemona

et al. 2021

IJMS

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Background: this study aims to investigate the possible association among the histopathologic features of carotid plaque instability, the presence of micro- or macrocalcifications, the expression of in situ inflammatory biomarkers, and the occurrence of the major risk factors in this process in a large series of carotid plaques. Methods: a total of 687 carotid plaques from symptomatic and asymptomatic patients were collected. Histological evaluation was performed to classify the calcium deposits in micro or macrocalcifications according to their morphological features (location and size). Immunohistochemistry was performed to study the expression of the main inflammatory biomarkers. Results: results here reported demonstrated that calcifications are very frequent in carotid plaques, with a significant difference between the presence of micro- and macrocalcifications. Specifically, microcalcifications were significantly associated to high inflamed unstable plaques. Paradoxically, macrocalcifications seem to stabilize the plaque and are associated to a M2 macrophage polarization instead. Discussion: the characterization of mechanisms involved in the formation of carotid calcifications can lay the foundation for developing new strategies for the management of patients affected by carotid atherosclerosis. Data of this study could provide key elements for an exhaustive evaluation of carotid plaque calcifications allowing to establish the risk of associated clinical events.

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“…The clinical impact of calcification on cardiovascular endpoints can paradigmatically be demonstrated in coronary artery disease [141]. Although the morphology and functional impact of atherosclerotic plaques (occlusive vs. non-occlusive) must be taken into account, the mere calcium scoring of coronary arteries in high-resolution computed tomography has become an important risk factor that influences guidelines for patient management, as for example, the indication for statin treatment [141,142]. Vascular calcification is promoted by different mechanisms, including an abnormal osteogenic differentiation of vascular smooth muscle cells, the death of vascular smooth muscle cells, increased Pi levels, e.g., due to increased TNAP and Phospho1 activity or in chronic kidney disease, and chronic inflammation [120,143].…”

Section: Vascular Calcificationmentioning

confidence: 99%

Tissue-Nonspecific Alkaline Phosphatase—A Gatekeeper of Physiological Conditions in Health and a Modulator of Biological Environments in Disease

et al. 2020

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Tissue-nonspecific alkaline phosphatase (TNAP) is a ubiquitously expressed enzyme that is best known for its role during mineralization processes in bones and skeleton. The enzyme metabolizes phosphate compounds like inorganic pyrophosphate and pyridoxal-5′-phosphate to provide, among others, inorganic phosphate for the mineralization and transportable vitamin B6 molecules. Patients with inherited loss of function mutations in the ALPL gene and consequently altered TNAP activity are suffering from the rare metabolic disease hypophosphatasia (HPP). This systemic disease is mainly characterized by impaired bone and dental mineralization but may also be accompanied by neurological symptoms, like anxiety disorders, seizures, and depression. HPP characteristically affects all ages and shows a wide range of clinical symptoms and disease severity, which results in the classification into different clinical subtypes. This review describes the molecular function of TNAP during the mineralization of bones and teeth, further discusses the current knowledge on the enzyme’s role in the nervous system and in sensory perception. An additional focus is set on the molecular role of TNAP in health and on functional observations reported in common laboratory vertebrate disease models, like rodents and zebrafish.

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Coronary artery calcium scoring: an evidence‐based guide for primary care physicians

Abstract: Coronary artery calcium scoring: an evidence-based guide for primary care physicians (Review).

Cited by 37 publications

References 85 publications

Prevalence of Subclinical Coronary Artery Atherosclerosis in the General Population

Prevalence of Subclinical Coronary Artery Atherosclerosis in the General Population

The Paradox Effect of Calcification in Carotid Atherosclerosis: Microcalcification Is Correlated with Plaque Instability

Tissue-Nonspecific Alkaline Phosphatase—A Gatekeeper of Physiological Conditions in Health and a Modulator of Biological Environments in Disease

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