Ten-year association of coronary artery calcium with atherosclerotic cardiovascular disease (ASCVD) events: the multi-ethnic study of atherosclerosis (MESA)

Abstract

Coronary artery calcium is associated strongly and in a graded fashion with 10-year risk of incident ASCVD as it is for CHD, independent of standard risk factors, and similarly by age, gender, and ethnicity. While 10-year event rates in those with CAC = 0 were almost exclusively below 5%, those with CAC ≥ 100 were consistently above 7.5%, making these potentially valuable cutpoints for the consideration of preventive therapies. Coronary artery calcium strongly predicts risk with the same magnitude of effect in all races, age groups, and both sexes, which makes it among the most useful markers for predicting ASCVD risk.

Something Old Predicting Something New

“…CAC score has been independently associated in a with 10-year risk of adverse cardiac outcomes including myocardial infarction and stroke. 18 We must note that the current study results for the first time, independently link change in CAC score over time with adverse cardiac remodeling which can act as surrogate to HF but does not provide information about outcomes such as HF incidence/ severity. These myocardial changes that accompany CAC progression may be critical to explain the worsening outcomes seen with CAC progression in several large trials.…”

“…CAC progression has been shown to be an independent predictor of incident coronary heart disease events in all 4 of the MESA race/ethnic groups. 18 Other large cohort studies also demonstrate CAC progression associated with increased all-cause mortality, 19 and certainly the potential for associated changes in the myocardium may be contributory.…”

An updated review of lipid‐modifying therapy

“…Selection of patients in primary prevention for lipid therapy is sometimes challenging and guidelines suggest a potential role here for coronary artery calcium (CAC) scoring . The CAC score has been shown to be predictive of CVD events . The American guidelines, in brief, suggest that with a CAC score of 0, statins may be withheld if other major risk factors are absent; a CAC score from 1 to 99 favours statin therapy, especially in patients aged 55 years or over; a CAC score of 100 or over strongly favours statin therapy in any adult, if no contraindication exists .…”

“…57,58 The CAC score has been shown to be predictive of CVD events. 59 The American guidelines, in brief, suggest that with a CAC score of 0, statins may be withheld if other major risk factors are absent; a CAC score from 1 to 99 favours statin therapy, especially in patients aged 55 years or over; a CAC score of 100 or over strongly favours statin therapy in any adult, if no contraindication exists. 57 The pattern of recommendation in Australian guidelines is somewhat similar, but CAC assessment in not covered by Medicare reimbursement.…”

Aspirin to Prevent Sudden Cardiac Death in Athletes with High Coronary Artery Calcium Scores

“…34,35 Associated in a graded fashion with incident coronary heart disease and death in adults aged 32 to 46 years, coronary artery calcium scores > 100 Agatston units identify a 10-year cardiovascular risk above the 7.5% threshold, justifying additional measures for primary prevention, including aspirin prophylaxis as evidence-based to be cardioprotective in the sameaged men. [36][37][38] Such targeted use to reduce the high risk for acute cardiac events due to rupture of transiently unstable atherosclerotic plaques during strenuous sports is distinct from recent evidence showing no clear benefit in persons at average risk. 39 One's coronary artery calcium score is the test result every athlete should know to discuss aspirin use with their primary care physician.…”