What Is the Prognostic Value of a Zero Calcium Score?

Redberg, Rita F.

doi:10.1016/j.jacc.2009.08.076

Cited by 12 publications

(3 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Depsite the lack of any published prospective data supporting this hypothesis, there remains a common misperception that knowledge of CAC could lead to more (potentially unnecessary) revascularizations. 21 This study affords some evaluation of this potential issue by comparing the revascularization rates between populations that were aware (MESA) and not aware (HNR) of their CAC status. The 5-year revascularization rates, in these two cohorts, were relatively low.…”

Section: Discussionmentioning

confidence: 99%

A comparison of outcomes with coronary artery calcium scanning in unselected populations: The Multi-Ethnic Study of Atherosclerosis (MESA) and Heinz Nixdorf RECALL study (HNR)

Budoff

Möhlenkamp

McClelland

et al. 2013

Journal of Cardiovascular Computed Tomography

View full text Add to dashboard Cite

Background The Multi-Ethnic Study of Atherosclerosis (MESA) and the Heinz Nixdorf Recall Study (HNR)) differed in regards to informing physicians and patients of the results of their subclinical atherosclerosis. Objective This study investigates whether the association of coronary artery calcium (CAC) with incident non-fatal and fatal cardiovascular (CVD) events is different among these two large, population-based observational studies. Methods All Caucasian subjects aged 45–75 years, free of baseline cardiovascular disease were included (n=2232 in MESA, n=3119 HNR participants). We studied the association between CAC and event rates at 5 years, including hard cardiac events (MI, cardiac death, resuscitated cardiac arrest), and separately added revascularizations, and strokes (fatal and non-fatal) to determine adjusted hazard ratios (HR). Results Both cohorts demonstrated very low CHD (including revascularization) rates with zero calcium (1.13 and 1.16% over 5 years in MESA and HNR respectively) and increasing significantly in both groups with CAC 100–399 (6.71 and 4.52% in MESA and HNR) and CAC >400 (12.5 and 13.54% in MESA and HNR respectively) and demonstrating strong independent predictive values for scores of 100–399 and >400, despite multivariable adjustment for risk factors. Risk factor adjusted five year revascularization rates were nearly identical for HNR and MESA, and generally low for both studies (1.4% [45/3119] for HNR and 1.9% [43/2232] for MESA) over 5 years. Conclusions Across two culturally diverse populations, CAC >400 is a strong predictor of events. High CAC did not determininistically result in revascularization and knowledge of CAC did not increase revascularizations.

show abstract

Section: Discussionmentioning

confidence: 99%

A comparison of outcomes with coronary artery calcium scanning in unselected populations: The Multi-Ethnic Study of Atherosclerosis (MESA) and Heinz Nixdorf RECALL study (HNR)

Budoff

Möhlenkamp

McClelland

et al. 2013

Journal of Cardiovascular Computed Tomography

View full text Add to dashboard Cite

show abstract

“…Of those, about 20% had a high pretest probability of CHD, 75% had an intermediate, and 5% had a low probability of CHD. In an accompanying editorial, Redberg588 commented the practice should be discouraged, largely due to the failure to predict 19% of patients with CHD as well as a finite radiation risk. While the radiation for CAC is minimal, with a median value of ≈3 mSv, roughly equal to that of a mammogram or 100 chest x-rays, the variation is considerable (2–7 mSv),224 and multiple scans in the same patient are becoming more common.…”

Section: Residual Risk Remains a Source Of Concernmentioning

confidence: 99%

Primary prevention of coronary heart disease: integration of new data, evolving views, revised goals, and role of rosuvastatin in management. A comprehensive survey

Kones¹

2011

DDDT

218

145

View full text Add to dashboard Cite

A recent explosion in the amount of cardiovascular risk and incipient, undetected subclinical cardiovascular pathology has swept across the globe. Nearly 70% of adult Americans are overweight or obese; the prevalence of visceral obesity stands at 53% and continues to rise. At any one time, 55% of the population is on a weight-loss diet, and almost all fail. Fewer than 15% of adults or children exercise sufficiently, and over 60% engage in no vigorous activity. Among adults, 11%–13% have diabetes, 34% have hypertension, 36% have prehypertension, 36% have prediabetes, 12% have both prediabetes and prehypertension, and 15% of the population with either diabetes, hypertension, or dyslipidemia are undiagnosed. About one-third of the adult population, and 80% of the obese, have fatty livers. With 34% of children overweight or obese, prevalence having doubled in just a few years, type 2 diabetes, hypertension, dyslipidemia, and fatty livers in children are at their highest levels ever. Half of adults have at least one cardiovascular risk factor. Not even 1% of the population attains ideal cardiovascular health. Despite falling coronary death rates for decades, coronary heart disease (CHD) death rates in US women 35 to 54 years of age may now be increasing because of the obesity epidemic. Up to 65% of patients do not have their conventional risk biomarkers under control. Only 30% of high risk patients with CHD achieve aggressive low density lipoprotein (LDL) targets. Of those patients with multiple risk factors, fewer than 10% have all of them adequately controlled. Even when patients are titrated to evidence-based targets, about 70% of cardiac events remain unaddressed. Undertreatment is also common. About two-thirds of high risk primary care patients are not taking needed medications for dyslipidemia. Poor patient adherence, typically below 50%, adds further difficulty. Hence, after all such fractional reductions are multiplied, only a modest portion of total cardiovascular risk burden is actually being eliminated, and the full potential of risk reduction remains unrealized. Worldwide the situation is similar, with the prevalence of metabolic syndrome approaching 50%. Primordial prevention, resulting from healthful lifestyle habits that do not permit the appearance of risk factors, is the preferred method to lower cardiovascular risk. Lowering the prevalence of obesity is the most urgent matter, and is pleiotropic since it affects blood pressure, lipid profiles, glucose metabolism, inflammation, and atherothrombotic disease progression. Physical activity also improves several risk factors, with the additional potential to lower heart rate. Given the current obstacles, success of primordial prevention remains uncertain. At the same time, the consequences of delay and inaction will inevitably be disastrous, and the sense of urgency mounts. Since most CHD events arise in a large subpopulation of low- to moderate-risk individuals, identifying a high proportion of those who will go on to develop events with accuracy remains...

show abstract

“…51, 52 Yet, the EISNER trial did not show a difference in downstream medical testing between those who did and did not undergo CAC scanning. 44 Current guidelines state that stress myocardial perfusion imaging may be considered in asymptomatic individuals at high risk of coronary heart disease, such as those with a CAC score >400 (class IIb recommendation).…”

Section: Do Imaging Tests (Such As Cac Scoring) Translate Into a Chanmentioning

confidence: 99%

Is There a Role for Coronary Artery Calcium Scoring for Management of Asymptomatic Patients at Risk for Coronary Artery Disease?

Andersson

Vasan²

2014

Circ: Cardiovascular Imaging

View full text Add to dashboard Cite

What Is the Prognostic Value of a Zero Calcium Score?

Cited by 12 publications

References 6 publications

A comparison of outcomes with coronary artery calcium scanning in unselected populations: The Multi-Ethnic Study of Atherosclerosis (MESA) and Heinz Nixdorf RECALL study (HNR)

A comparison of outcomes with coronary artery calcium scanning in unselected populations: The Multi-Ethnic Study of Atherosclerosis (MESA) and Heinz Nixdorf RECALL study (HNR)

Primary prevention of coronary heart disease: integration of new data, evolving views, revised goals, and role of rosuvastatin in management. A comprehensive survey

Is There a Role for Coronary Artery Calcium Scoring for Management of Asymptomatic Patients at Risk for Coronary Artery Disease?

Contact Info

Product

Resources

About