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Coronary Artery Calcium: Recommendations for Risk Assessment in Cardiovascular Prevention Guidelines

  • Imaging (Q Truong, Section Editor)
  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

A Correction to this article was published on 18 October 2018

This article has been updated

Abstract

Purpose of review

In this review, we evaluate the coronary artery calcium (CAC) score as a biomarker for advanced atherosclerotic cardiovascular disease (ASCVD) risk assessment.

Recent findings

We summarize the evidence from multiple epidemiological studies, which show a clear advantage of CAC compared to traditional and non-traditional cardiovascular risk factors. We then compare the recommendations included in the 2013 American College of Cardiology/American Heart Association (ACC/AHA) and in the 2017 Society of Cardiovascular Computed Tomography (SCCT) guidelines for the use of CAC in ASCVD risk assessment, and examine the recent 2018 US Preventive Services Task Force (USPSTF) document. Finally, based on the currently available evidence, we provide constructive input for the upcoming ACC/AHA guidelines, regarding the population in whom CAC is most likely to be informative, the level of evidence that we believe should be assigned to CAC as an advanced ASCVD risk assessment tool, and the special populations in whom CAC might be beneficial for further risk assessment.

Summary

We support a pragmatic approach that combines the pooled cohort equations (PCE) for initial ASCVD risk stratification, followed by CAC for refining ASCVD risk assessment among a broad range of intermediate risk patients and other special groups.

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Change history

  • 18 October 2018

    In the recently published review “Coronary Artery Calcium: Recommendations for Risk Assessment in Cardiovascular Prevention Guidelines,” the following author name was inadvertently misspelled as Alison Peng. The correct spelling of the author’s name is: Allison Peng as shown above.

Abbreviations

ACC/AHA:

American College of Cardiology/American Heart Association

ASCVD:

Atherosclerotic cardiovascular disease events

CAC:

Coronary artery calcium

CHD:

Coronary heart disease

cPCE:

Calibrated pooled cohort equations

MESA:

Multi-ethnic study of atherosclerosis

NNSI:

Number needed to screen to identify

NRI:

Net reclassification improvement

PCE:

Pooled cohort equations

SCCT:

Society of Cardiovascular Computed Tomography

USPSTF:

US Preventive Services Task Force

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Author information

Authors and Affiliations

  1. Department of Internal Medicine, The University of Kansas School of Medicine, Wichita, KS, USA

    Mahmoud Al Rifai MD MPH

  2. Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Blalock 524D1, 600 N Wolfe St, Baltimore, MD, 21287, USA

    Mahmoud Al Rifai MD MPH, Miguel Cainzos-Achirica MD MPH, Sina Kianoush MD MPH, Mohammadhassan Mirbolouk MD, Allison Peng BS & Michael J. Blaha MD MPH

  3. Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain

    Miguel Cainzos-Achirica MD MPH & Josep Comin-Colet MD PhD

  4. Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain

    Miguel Cainzos-Achirica MD MPH & Josep Comin-Colet MD PhD

  5. RTI Health Solutions, Pharmacoepidemiology and Risk Management, Barcelona, Spain

    Miguel Cainzos-Achirica MD MPH

  6. Department of Internal Medicine, Yale New Haven Medical Center Waterbury Program, Waterbury, CT, USA

    Sina Kianoush MD MPH

  7. Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain

    Josep Comin-Colet MD PhD

  8. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA

    Michael J. Blaha MD MPH

Authors
  1. Mahmoud Al Rifai MD MPH
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  2. Miguel Cainzos-Achirica MD MPH
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  3. Sina Kianoush MD MPH
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  4. Mohammadhassan Mirbolouk MD
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  5. Allison Peng BS
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  6. Josep Comin-Colet MD PhD
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  7. Michael J. Blaha MD MPH
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Corresponding author

Correspondence to Michael J. Blaha MD MPH.

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Conflict of Interest

Mahmoud Al Rifai, Miguel Cainzos-Achirica, Sina Kianoush, Mohammadhassan Mirbolouk, Allison Peng, and Josep Comin-Colet each declare no potential conflicts of interest.

Michael J. Blaha reports grants from NIH, FDA, Aetna Foundation, and Amgen Foundation and honoraria from Amgen, Sanofi, Regeneron, Medimmune, Novartis, Alcea, and Novo Nordisk.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

The original version of this article was revised: In the recently published review Coronary Artery Calcium: Recommendation for Risk Assessment in Cardiovascular Prevention Guidelines,” the following author name was inadvertently misspelled as Alison Peng.

This article is part of the Topical Collection on Imaging

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Al Rifai, M., Cainzos-Achirica, M., Kianoush, S. et al. Coronary Artery Calcium: Recommendations for Risk Assessment in Cardiovascular Prevention Guidelines. Curr Treat Options Cardio Med 20, 89 (2018). https://doi.org/10.1007/s11936-018-0685-0

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