Abstract
As the leading cause of death in the world, cardiovascular disease remains the most challenging era in the academic research. Early diagnosis of cardiovascular disease could help clinicians to utilize suitable preventive therapies and reduce mortality, morbidity and medical costs related to cardiovascular events. Preventive cardiology has focused on stablishing methods to identify high risk individuals for cardiac disease events. In the past thirty years, coronary artery calcium (CAC) has been studied and validated as a robust reliable indicator of subclinical atherosclerosis. Development of cardiac computed tomography (CT) made quantification of CAC score faster and more available to use. Given the Non-invasive nature of CAC scoring, investigators evaluated the CAC score in long-term population-based cohort studies. Numerous studies demonstrated that CAC score, more than other factors, correlates with likelihood of future cardiac events in the symptomatic and asymptomatic individuals. The higher CAC score predicts the higher probability of cardiovascular events in the future. One the other hand, CAC score of zero is associated with lower chance of cardiac events. Although the CAC score is a reliable predictive factor for cardiovascular events, considering all of the patient’s risk factors including traditional risk factors is suggested. This chapter discusses the history of coronary artery calcium, its predictive and prognostic value for future cardiovascular events, cost-effectiveness of CAC scoring and implication of CAC score of zero as negative risk factor for the cardiovascular event.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Bartel AG, et al. The significance of coronary calcification detected by fluoroscopy. A report of 360 patients. Circulation. 1974;49(6):1247–53.
Margolis JR, et al. The diagnostic and prognostic significance of coronary artery calcification. A report of 800 cases. Radiology. 1980;137(3):609–16.
Agatston AS, et al. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 1990;15(4):827–32.
Mao SS, et al. Comparison of coronary artery calcium scores between electron beam computed tomography and 64-multidetector computed tomographic scanner. J Comput Assist Tomogr. 2009;33(2):175–8.
Budoff MJ, et al. Coronary artery and thoracic calcium on noncontrast thoracic CT scans: comparison of ungated and gated examinations in patients from the COPD Gene cohort. J Cardiovasc Comput Tomogr. 2011;5(2):113–8.
Shemesh J, et al. Ordinal scoring of coronary artery calcifications on low-dose CT scans of the chest is predictive of death from cardiovascular disease. Radiology. 2010;257(2):541–8.
Dawber TR, Meadors GF, Moore FE Jr. Epidemiological approaches to heart disease: the Framingham Study. Am J Public Health Nations Health. 1951;41(3):279–81.
Kannel WB, et al. An investigation of coronary heart disease in families. The Framingham offspring study. Am J Epidemiol. 1979;110(3):281–90.
Wilson PWF, et al. Prediction of coronary heart disease using risk factor categories. Circulation. 1998;97(18):1837–47.
Splansky GL, et al. The Third Generation Cohort of the National Heart, Lung, and Blood Institute’s Framingham Heart Study: design, recruitment, and initial examination. Am J Epidemiol. 2007;165(11):1328–35.
Hoffmann U, et al. Defining normal distributions of coronary artery calcium in women and men (from the Framingham Heart Study). Am J Cardiol. 2008;102(9):1136–1141.e1.
Ferencik M, et al. Coronary artery calcium distribution is an independent predictor of incident major coronary heart disease events. Circ Cardiovasc Imaging. 2017;10(10):e006592.
Hofman A, et al. Determinants of disease and disability in the elderly: the Rotterdam Elderly Study. Eur J Epidemiol. 1991;7(4):403–22.
Vliegenthart R, et al. Coronary calcification improves cardiovascular risk prediction in the elderly. Circulation. 2005;112(4):572–7.
Vliegenthart R, et al. Coronary calcification detected by electron-beam computed tomography and myocardial infarction. The Rotterdam Coronary Calcification Study. Eur Heart J. 2002;23(20):1596–603.
Bild DE, et al. Multi-Ethnic Study of Atherosclerosis: objectives and design. Am J Epidemiol. 2002;156(9):871–81.
Greenland P, et al. Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. JAMA. 2004;291(2):210–5.
Taylor AJ, et al. 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.
Detrano R, et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med. 2008;358(13):1336–45.
Kronmal RA, et al. Risk factors for the progression of coronary artery calcification in asymptomatic subjects. Circulation. 2007;115(21):2722–30.
Blaha MJ, et al. Role of coronary artery calcium score of zero and other negative risk markers for cardiovascular disease. Circulation. 2016;133(9):849–58.
Schmermund A, et al. Assessment of clinically silent atherosclerotic disease and established and novel risk factors for predicting myocardial infarction and cardiac death in healthy middle-aged subjects: rationale and design of the Heinz Nixdorf RECALL Study. Risk Factors, Evaluation of Coronary Calcium and Lifestyle. Am Heart J. 2002;144(2):212–8.
Lehmann N, et al. Value of progression of coronary artery calcification for risk prediction of coronary and cardiovascular events. Circulation. 2018;137(7):665–79.
Blaha MJ, et al. Rationale and design of the coronary artery calcium consortium: a multicenter cohort study. J Cardiovasc Comput Tomogr. 2017;11(1):54–61.
Grandhi GR, et al. Interplay of coronary artery calcium and risk factors for predicting CVD/CHD mortality: the CAC consortium. JACC Cardiovasc Imaging. 2020;13(5):1175–86.
Arad Y, et al. Prediction of coronary events with electron beam computed tomography. J Am Coll Cardiol. 2000;36(4):1253–60.
Raggi P, Cooil B, Callister TQ. Use of electron beam tomography data to develop models for prediction of hard coronary events. Am Heart J. 2001;141(3):375–82.
Kondos GT, et al. Electron-beam tomography coronary artery calcium and cardiac events: a 37-month follow-up of 5635 initially asymptomatic low- to intermediate-risk adults. Circulation. 2003;107(20):2571–6.
Shaw LJ, et al. Prognostic value of cardiac risk factors and coronary artery calcium screening for all-cause mortality. Radiology. 2003;228(3):826–33.
Arad Y, et al. Coronary calcification, coronary disease risk factors, C-reactive protein, and atherosclerotic cardiovascular disease events: the St. Francis Heart Study. J Am Coll Cardiol. 2005;46(1):158–65.
LaMonte MJ, et al. Coronary artery calcium score and coronary heart disease events in a large cohort of asymptomatic men and women. Am J Epidemiol. 2005;162(5):421–9.
Budoff MJ, et al. Long-term prognosis associated with coronary calcification: observations from a registry of 25,253 patients. J Am Coll Cardiol. 2007;49(18):1860–70.
Detrano R, et al. Prognostic value of coronary calcification and angiographic stenoses in patients undergoing coronary angiography. J Am Coll Cardiol. 1996;27(2):285–90.
Becker A, et al. Prädiktion kardiovaskulärer Ereignisse durch Koronarkalkbestimmung mit der Mehrzeilen-Computertomographie. Dtsch Med Wochenschr. 2005;130(43):2433–8.
Rozanski A, et al. Clinical outcomes after both coronary calcium scanning and exercise myocardial perfusion scintigraphy. J Am Coll Cardiol. 2007;49(12):1352–61.
Schenker MP, et al. Interrelation of coronary calcification, myocardial ischemia, and outcomes in patients with intermediate likelihood of coronary artery disease: a combined positron emission tomography/computed tomography study. Circulation. 2008;117(13):1693–700.
van Kempen BJ, et al. Comparative effectiveness and cost-effectiveness of computed tomography screening for coronary artery calcium in asymptomatic individuals. J Am Coll Cardiol. 2011;58(16):1690–701.
Pletcher MJ, et al. Using the coronary artery calcium score to guide statin therapy: a cost-effectiveness analysis. Circ Cardiovasc Qual Outcomes. 2014;7(2):276–84.
Roberts ET, et al. Cost-effectiveness of coronary artery calcium testing for coronary heart and cardiovascular disease risk prediction to guide statin allocation: the Multi-Ethnic Study of Atherosclerosis (MESA). PLoS One. 2015;10(3):e0116377.
Galper BZ, Wang YC, Einstein AJ. Strategies for primary prevention of coronary heart disease based on risk stratification by the ACC/AHA lipid guidelines, ATP III guidelines, coronary calcium scoring, and C-reactive protein, and a global treat-all strategy: a comparative – effectiveness modeling study. PLoS One. 2015;10(9):e0138092.
Hong JC, et al. Implications of coronary artery calcium testing for treatment decisions among statin candidates according to the ACC/AHA cholesterol management guidelines: a cost-effectiveness analysis. JACC Cardiovasc Imaging. 2017;10(8):938–52.
van Kempen BJH, et al. Comparing the cost-effectiveness of four novel risk markers for screening asymptomatic individuals to prevent cardiovascular disease (CVD) in the US population. Int J Cardiol. 2016;203:422–31.
Blaha MJ, Blankstein R, Nasir K. Coronary artery calcium scores of zero and establishing the concept of negative risk factors. J Am Coll Cardiol. 2019;74(1):12–4.
Blaha M, et al. Absence of coronary artery calcification and all-cause mortality. JACC Cardiovasc Imaging. 2009;2(6):692–700.
Tota-Maharaj R, et al. Coronary artery calcium for the prediction of mortality in young adults <45 years old and elderly adults >75 years old. Eur Heart J. 2012;33(23):2955–62.
Silverman MG, et al. Impact of coronary artery calcium on coronary heart disease events in individuals at the extremes of traditional risk factor burden: the Multi-Ethnic Study of Atherosclerosis. Eur Heart J. 2014;35(33):2232–41.
Martin SS, et al. Dyslipidemia, coronary artery calcium, and incident atherosclerotic cardiovascular disease: implications for statin therapy from the multi-ethnic study of atherosclerosis. Circulation. 2014;129(1):77–86.
Malik S, et al. Coronary artery calcium score for long-term risk classification in individuals with type 2 diabetes and metabolic syndrome from the multi-ethnic study of atherosclerosis. JAMA Cardiol. 2017;2(12):1332–40.
Handy CE, et al. The association of coronary artery calcium with noncardiovascular disease: the multi-ethnic study of atherosclerosis. JACC Cardiovasc Imaging. 2016;9(5):568–76.
Blaha MJ, et al. Role of coronary artery calcium score of zero and other negative risk markers for cardiovascular disease: The Multi-Ethnic Study of Atherosclerosis (MESA). Circulation. 2016;133(9):849–58.
Mortensen MB, et al. Negative risk markers for cardiovascular events in the elderly. J Am Coll Cardiol. 2019;74(1):1–11.
Blaha MJ, et al. Associations between C-reactive protein, coronary artery calcium, and cardiovascular events: implications for the JUPITER population from MESA, a population-based cohort study. Lancet. 2011;378(9792):684–92.
Mitchell JD, et al. Impact of statins on cardiovascular outcomes following coronary artery calcium scoring. J Am Coll Cardiol. 2018;72(25):3233–42.
Cainzos-Achirica M, et al. Coronary artery calcium for personalized allocation of aspirin in primary prevention of cardiovascular disease in 2019. Circulation. 2020;141(19):1541–53.
Grundy SM, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the management of blood cholesterol: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;73(24):3168–209.
Arnett DK, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140(11):e596–646.
Min JK, et al. Determinants of coronary calcium conversion among patients with a normal coronary calcium scan: what is the “warranty period” for remaining normal? J Am Coll Cardiol. 2010;55(11):1110–7.
Koulaouzidis G, et al. Coronary artery calcification progression in asymptomatic individuals with initial score of zero. Angiology. 2013;64(7):494–7.
Lee W, et al. Evaluation of coronary artery calcium progression in asymptomatic individuals with an initial score of zero. Korean Circ J. 2019;49(5):448–57.
Budoff MJ, et al. Progression of coronary calcium and incident coronary heart disease events: MESA (Multi-Ethnic Study of Atherosclerosis). J Am Coll Cardiol. 2013;61(12):1231–9.
Dzaye O, et al. Incidence of new coronary calcification: time to conversion from CAC = 0. J Am Coll Cardiol. 2020;75(13):1610–3.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Rezvanizadeh, V., Budoff, M.J. (2022). Prognostic Value of Coronary Artery Calcium. In: Henein, M. (eds) Cardiovascular Calcification. Springer, Cham. https://doi.org/10.1007/978-3-030-81515-8_6
Download citation
DOI: https://doi.org/10.1007/978-3-030-81515-8_6
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-81514-1
Online ISBN: 978-3-030-81515-8
eBook Packages: MedicineMedicine (R0)