Current Cardiology Reports

, 20:10 | Cite as

Coronary Artery Calcium Scoring in Young Adults: Evidence and Challenges

  • Marwan Saad
  • Naga Venkata Pothineni
  • Joseph Thomas
  • Richa Parikh
  • Swathi Kovelamudi
  • Dina Elsayed
  • Ramez Nairooz
  • Frederick Feit
Ischemic Heart Disease (D Mukherjee, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Ischemic Heart Disease

Abstract

Purpose of Review

This review aims to summarize the evidence and challenges of coronary artery calcium (CAC) scoring as a screening tool for coronary artery disease (CAD) in young adults.

Recent Findings

Several cohort studies have highlighted the value of CAC scoring in CAD risk assessment in young adults. The largest study to date is the Coronary Artery Risk Development in Young Adults (CARDIA) study. The study examined patients at 18–30 years of age and demonstrated that the presence of any degree of CAC was associated with a higher risk of coronary events compared to zero CAC, with an incremental increase in the risk of events with higher scores. However, it is important to note that 70% of patients screened had CAC = 0 at the age of 56.

Summary

Despite the evidence that higher CAC score cutoff used in guidelines for predicting cardiovascular risk may be “falsely reassuring,” however, mass screening of young adults using CAC score may be challenging. The development of prediction tools and scoring systems to identify patients at higher risk of developing CAC based on known CAD risk factors may help reduce the number needed to screen to detect patients with positive CAC.

Keywords

Coronary Calcium score Young adults Age Review 

Abbreviations

ASCVD

Atherosclerotic cardiovascular disease

CAC

Coronary artery calcium

CAD

Coronary artery disease

CHD

Coronary heart disease

Notes

Compliance with Ethical Standards

Conflict of Interest

Marwan Saad MD, Naga Venkata Pothineni, Joseph Thomas, Richa Parikh, Swathi Kovelamudi, Dina Elsayed, Ramez Nairooz, and Frederick Feit declare that they have no conflict of interest.

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.

References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. 1.
    Goff DC, Lloyd-Jones DM, Bennett G, Coady S, D’Agostino RB, Gibbons R, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk. Circulation. 2014;129(25 suppl 2):S49–73.  https://doi.org/10.1161/01.cir.0000437741.48606.98.CrossRefPubMedGoogle Scholar
  2. 2.
    Greenland P, Alpert JS, Beller GA, Benjamin EJ, Budoff MJ, Fayad ZA, et al. 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2010;122(25):e584–636.  https://doi.org/10.1161/CIR.0b013e3182051b4c.CrossRefPubMedGoogle Scholar
  3. 3.
    Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(25):2889–934.  https://doi.org/10.1016/j.jacc.2013.11.002.CrossRefPubMedGoogle Scholar
  4. 4.
    •• Hecht H, Blaha MJ, Berman DS, Nasir K, Budoff M, Leipsic J, et al. Clinical indications for coronary artery calcium scoring in asymptomatic patients: expert consensus statement from the Society of Cardiovascular Computed Tomography. J Cardiovasc Comput Tomogr. 2017;11(2):157–68.  https://doi.org/10.1016/j.jcct.2017.02.010. This article presents the current recommendations about CAC as a screening tool for CAD.CrossRefPubMedGoogle Scholar
  5. 5.
    Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 1990;15(4):827–32.  https://doi.org/10.1016/0735-1097(90)90282-T.CrossRefPubMedGoogle Scholar
  6. 6.
    Blaha MJ, Mortensen MB, Kianoush S, Tota-Maharaj R, Cainzos-Achirica M. Coronary artery calcium scoring: is it time for a change in methodology? JACC Cardiovasc Imaging. 2017;10(8):923–37.  https://doi.org/10.1016/j.jcmg.2017.05.007.CrossRefPubMedGoogle Scholar
  7. 7.
    Liu W, Zhang Y, Yu C-M, Ji Q-W, Cai M, Zhao Y-X, et al. Current understanding of coronary artery calcification. J Geriatr Cardiol. 2015;12(6):668–75.  https://doi.org/10.11909/j.issn.1671-5411.2015.06.012.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Kalra SS, Shanahan CM. Vascular calcification and hypertension: cause and effect. Ann Med. 2012;44(Suppl 1):S85–92.  https://doi.org/10.3109/07853890.2012.660498.CrossRefPubMedGoogle Scholar
  9. 9.
    Wexler L, Brundage B, Crouse J, Detrano R, Fuster V, Maddahi J, et al. Coronary artery calcification: pathophysiology, epidemiology, imaging methods, and clinical implications. A statement for health professionals from the American Heart Association. Writing Group. Circulation. 1996;94(5):1175–92.  https://doi.org/10.1161/01.CIR.94.5.1175.CrossRefPubMedGoogle Scholar
  10. 10.
    Demer LL, Tintut Y. Vascular calcification: pathobiology of a multifaceted disease. Circulation. 2008;117(22):2938–48.  https://doi.org/10.1161/CIRCULATIONAHA.107.743161.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Okwuosa TM, Greenland P, Ning H, Liu K, Bild DE, Burke GL, et al. Distribution of coronary artery calcium scores by Framingham 10-year risk strata in the MESA (Multi-Ethnic Study of Atherosclerosis) potential implications for coronary risk assessment. J Am Coll Cardiol. 2011;57(18):1838–45.  https://doi.org/10.1016/j.jacc.2010.11.053.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Blaha M, Budoff MJ, Shaw LJ, Khosa F, Rumberger JA, Berman D, et al. Absence of coronary artery calcification and all-cause mortality. JACC. Cardiovasc. Imaging. 2009;2(6):692–700.  https://doi.org/10.1016/j.jcmg.2009.03.009.CrossRefPubMedGoogle Scholar
  13. 13.
    Sarwar A, Shaw LJ, Shapiro MD, Blankstein R, Hoffmann U, Hoffman U, et al. Diagnostic and prognostic value of absence of coronary artery calcification. JACC Cardiovasc Imaging. 2009;2(6):675–88.  https://doi.org/10.1016/j.jcmg.2008.12.031.CrossRefPubMedGoogle Scholar
  14. 14.
    Peters SAE, den Ruijter HM, Bots ML, Moons KGM. Improvements in risk stratification for the occurrence of cardiovascular disease by imaging subclinical atherosclerosis: a systematic review. Heart. 2012;98(3):177–84.  https://doi.org/10.1136/heartjnl-2011-300747.CrossRefPubMedGoogle Scholar
  15. 15.
    Taylor AJ, Bindeman J, Feuerstein I, Cao F, Brazaitis M, O’Malley PG. Coronary calcium independently predicts incident premature coronary heart disease over measured cardiovascular risk factors: mean three-year outcomes in the Prospective Army Coronary Calcium (PACC) project. J Am Coll Cardiol. 2005;46(5):807–14.  https://doi.org/10.1016/j.jacc.2005.05.049.CrossRefPubMedGoogle Scholar
  16. 16.
    Okwuosa TM, Greenland P, Ning H, Liu K, Lloyd-Jones DM. Yield of screening for coronary artery calcium in early middle-age adults based on the 10-year Framingham Risk Score: the CARDIA study. JACC Cardiovasc Imaging. 2012;5(9):923–30.  https://doi.org/10.1016/j.jcmg.2012.01.022.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Tota-Maharaj R, Blaha MJ, McEvoy JW, Blumenthal RS, Muse ED, Budoff MJ, et al. Coronary artery calcium for the prediction of mortality in young adults 75 years old. Eur Heart J. 2012;33(23):2955–62.  https://doi.org/10.1093/eurheartj/ehs230.CrossRefPubMedGoogle Scholar
  18. 18.
    •• Carr JJ, Jacobs DR, Terry JG, Shay CM, Sidney S, Liu K, et al. Association of Coronary Artery Calcium in adults aged 32 to 46 years with incident coronary heart disease and death. JAMA Cardiol. 2017;2(4):391–9.  https://doi.org/10.1001/jamacardio.2016.5493. The CARDIA study is among the largest studies that aimed to assess the role of CAC scoring in young to middle-aged adults.CrossRefPubMedGoogle Scholar
  19. 19.
    McCollough CH, Bushberg JT, Fletcher JG, Eckel LJ. Answers to common questions about the use and safety of CT scans. Mayo Clin Proc. 2015;90(10):1380–92.  https://doi.org/10.1016/j.mayocp.2015.07.011.CrossRefPubMedGoogle Scholar
  20. 20.
    Einstein AJ. Effects of radiation exposure from cardiac imaging: how good are the data? J Am Coll Cardiol. 2012;59(6):553–65.  https://doi.org/10.1016/j.jacc.2011.08.079.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Einstein AJ, Johnson LL, DeLuca AJ, Kontak AC, Groves DW, Stant J, et al. Radiation dose and prognosis of ultra-low-dose stress-first myocardial perfusion SPECT in patients with chest pain using a high-efficiency camera. J Nucl Med. 2015;56(4):545–51.  https://doi.org/10.2967/jnumed.114.150664.CrossRefPubMedGoogle Scholar
  22. 22.
    Lester SJ, Eleid MF, Khandheria BK, Hurst RT. Carotid intima-media thickness and coronary artery calcium score as indications of subclinical atherosclerosis. Mayo Clin Proc. 2009;84(3):229–33.  https://doi.org/10.4065/84.3.229.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Gepner AD, Young R, Delaney JA, Tattersall MC, Blaha MJ, Post WS, et al. Comparison of coronary artery calcium presence, carotid plaque presence, and carotid intima-media thickness for cardiovascular disease prediction in the multi-ethnic study of atherosclerosis. Circ Cardiovasc Imaging. 2015;8(1):e002262.  https://doi.org/10.1161/CIRCIMAGING.114.002262.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Hecht HS, Cronin P, Blaha MJ, Budoff MJ, Kazerooni EA, Narula J, et al. 2016 SCCT/STR guidelines for coronary artery calcium scoring of noncontrast noncardiac chest CT scans: a report of the Society of Cardiovascular Computed Tomography and Society of Thoracic Radiology. J Cardiovasc Comput Tomogr. 2017;11(1):74–84.  https://doi.org/10.1016/j.jcct.2016.11.003.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Marwan Saad
    • 1
    • 2
  • Naga Venkata Pothineni
    • 1
  • Joseph Thomas
    • 3
  • Richa Parikh
    • 3
  • Swathi Kovelamudi
    • 3
  • Dina Elsayed
    • 4
  • Ramez Nairooz
    • 5
  • Frederick Feit
    • 6
  1. 1.Division of Cardiovascular MedicineUniversity of Arkansas for Medical SciencesLittle RockUSA
  2. 2.Division of CardiologyAin Shams UniversityCairoEgypt
  3. 3.Department of MedicineUniversity of Arkansas for Medical SciencesLittle RockUSA
  4. 4.Division of Biomedical Informatics, Graduate SchoolUniversity of Arkansas for Medical SciencesLittle RockUSA
  5. 5.Division of Cardiovascular MedicineUniversity of South CaliforniaLos AngelesUSA
  6. 6.Division of Cardiovascular MedicineNew York University School of MedicineNew YorkUSA

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