Relation of cardiovascular risk factors and angina status to obstructive coronary artery disease according to categorical coronary artery calcium score

Abstract

Coronary artery calcium (CAC) is associated with the presence of coronary artery disease (CAD) and cardiovascular risk factors. However, the relation between cardiovascular risk factors and CAD has not yet been fully elucidated in patients with a zero or low coronary artery calcium score (CACS). The purpose of this study was to evaluate the relation of cardiovascular risk factors and angina status to obstructive CAD according to categorical CACS. A total of 753 patients were enrolled in this study. CAC scoring and coronary computed tomographic angiography (CCTA) were performed with dual-source 64-slice CT scanners. The number of patients with a CACS ≤10 and ≤100 were 358 and 528, respectively. Patients with a higher CACS were older and more frequently male, and had a greater frequency of hypertension, diabetes, and hypercholesterolemia. The prevalence of obstructive CAD increased with the CACS. Among patients with a CACS ≤100, age, male gender, diabetes, hypercholesterolemia, and typical angina pectoris were related to obstructive CAD. The presence of hypercholesterolemia was relatively strongly associated with obstructive CAD (OR 6.67, 95% CI 2.91-15.3, p < 0.001) on multivariate analysis. Among patients with a CACS ≤10, men, hypercholesterolemia, and typical angina pectoris were significantly more frequent in patients with than in those without obstructive CAD (p < 0.01). Our data suggest that neither the absence nor low of coronary calcium burden may reliably exclude obstructive CAD in typical symptomatic male patients with hypercholesterolemia. This result may be useful to interpret the relation of CACS to obstructive CAD.

What is the optimal cut-off point for low coronary artery calcium score assessed by computed tomography? Multi-Detector Computed Tomography ANIN Registry

“…Importantly, when we compare patients with a CAC score of 10-100 to patients with a CAC score ≤ 10, the incidence of CAD rises significantly (∼5-fold). Our results are similar to the previous results of Ueda, who reported that the incidence of CAD increased 6-fold in the CAC 10-100 score group [22, 23]. When a CAC score < 100 is classified as low, the high risk non-calcified obstructive CAD is simply overestimated.…”

Predictive Factors of the Presence and Number of Noncalcified Coronary Plaque in Japanese Patients with Zero Coronary Artery Calcium Score Using 64-Slice Multi-Detector Computed Tomography

“…The variation is thought to be due to differences in patients' characteristics, such as clinical pre- 117 sentation, race, gender and risk factors [9,19], and generally, reviewing the above recent reports, NCP or obstructive coronary lesions appear more frequent in study populations at higher risk for CAD. On the other hand, there are not many studies with Asian, especially Japanese patients, which reveal that the prevalence of NCP and obstructive coronary lesions in patients with zero CACS is 12% and 2.4% ~ 3.1%, respectively [11,17,19]. The present study found that 11% of the patients without CAC had significant stenosis, 32% of them had NCP, and 7% of them had NCP with both PR and LP.…”

Association of midregional proadrenomedullin with coronary artery stenoses, soft atherosclerotic plaques and coronary artery calcium

“…Whereas in other studies the calcification process was investigated in vitro and in animal models (rats) being fed with vitamin D and nicotine [6,23], the present study was performed in subjects with normal renal function and balanced calciumphosphate homeostasis. Another difference is the technique applied for the evaluation of calcification processes, which was atomic absorption spectrophotometry in invitro studies [6,21] and 64-MSCT imaging in our study, which is the gold standard technique for the non-invasive evaluation of the CACS in various clinical settings [24][25][26]. Our study is limited by the small samples size.…”