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Coronary Artery Calcium Imaging for Risk Stratification

  • Nikolaos Alexopoulos
  • Paolo Raggi
Chapter
Part of the Contemporary Cardiology book series (CONCARD)

Abstract

Striking advancements in cardiovascular diagnostics and therapeutics during the last several decades produced a marked decrease in mortality due to atherosclerotic diseases in western societies. Nonetheless, coronary artery disease (CAD) remains the main cause of death, being responsible for more deaths than all cancers combined, and it is associated with substantial functional impairment in survivors of acute events, imposing a very large economical burden on society. Numerous risk scores based on identifiable patients’ characteristics were developed to improve identification of patients at higher risk of events, to whom intensive preventive therapies should be directed. Nonetheless, most of these tools are incompletely effective, and the majority of events develop in subjects not considered to be at high risk. The attention of several investigators therefore turned to the development of imaging tools to identify atherosclerosis or its signature in its preclinical stages. Coronary artery calcium (CAC) imaging is one of the imaging tests that received the most attention in the past 20 years, and one that has raised a large controversy among field experts. That calcium deposition accompanies the formation of atherosclerotic plaque from its inception has been well-known for two centuries. More recently, it has become apparent that CAC deposition occurs via active processes of calcification resembling bone formation. Finally, the calcified portion represents approximately 15–20% of the total atheroma volume. In this chapter, we will review the most relevant literature on the use of CAC as a risk stratification tool of asymptomatic patients as well as the utility of sequential CAC scanning to follow the evolution of atherosclerosis.

Keywords

Calcium Diabetes Mellitus Risk factor Assessment 

References

  1. 1.
    Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 1990;15(4):827–32.CrossRefGoogle Scholar
  2. 2.
    Callister TQ, Cooil B, Raya SP, Lippolis NJ, Russo DJ, Raggi P. Coronary artery disease: improved reproducibility of calcium scoring with an electron-beam CT volumetric method. Radiology. 1998;208(3):807–14.CrossRefPubMedGoogle Scholar
  3. 3.
    Rumberger JA, Kaufman L. A rosetta stone for coronary calcium risk stratification: agatston, volume, and mass scores in 11,490 individuals. AJR Am J Roentgenol. 2003;181(3):743–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Becker CR, Kleffel T, Crispin A, Knez A, Young J, Schoepf UJ, Haberl R, Reiser MF. Coronary artery calcium measurement: agreement of multirow detector and electron beam CT. AJR Am J Roentgenol. 2001;176(5):1295–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Knez A, Becker C, Becker A, Leber A, White C, Reiser M, Steinbeck G. Determination of coronary calcium with multi-slice spiral computed tomography: a comparative study with electron-beam CT. Int J Cardiovasc Imaging. 2002;18(4):295–303.CrossRefPubMedGoogle Scholar
  6. 6.
    Kondos GT, Hoff JA, Sevrukov A, Daviglus ML, Garside DB, Devries SS, Chomka EV, Liu K. 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.CrossRefPubMedGoogle Scholar
  7. 7.
    Shaw LJ, Raggi P, Schisterman E, Berman DS, Callister TQ. Prognostic value of cardiac risk factors and coronary artery calcium screening for all-cause mortality. Radiology. 2003;228(3):826–33.CrossRefPubMedGoogle Scholar
  8. 8.
    Budoff MJ, Shaw LJ, Liu ST, Weinstein SR, Mosler TP, Tseng PH, Flores FR, Callister TQ, Raggi P, Berman DS. Long-term prognosis associated with coronary calcification: observations from a registry of 25,253 patients. J Am Coll Cardiol. 2007;49(18):1860–70.CrossRefGoogle Scholar
  9. 9.
    Arad Y, Goodman KJ, Roth M, Newstein D, Guerci AD. 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.CrossRefPubMedGoogle Scholar
  10. 10.
    Greenland P, LaBree L, Azen SP, Doherty TM, Detrano RC. Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. JAMA. 2004;291(2):210–5.CrossRefPubMedGoogle Scholar
  11. 11.
    LaMonte MJ, FitzGerald SJ, Church TS, Barlow CE, Radford NB, Levine BD, Pippin JJ, Gibbons LW, Blair SN, Nichaman MZ. 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.CrossRefPubMedGoogle Scholar
  12. 12.
    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.CrossRefGoogle Scholar
  13. 13.
    Detrano R, Guerci AD, Carr JJ, Bild DE, Burke G, Folsom AR, Liu K, Shea S, Szklo M, Bluemke DA, O’Leary DH, Tracy R, Watson K, Wong ND, Kronmal RA. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med. 2008;358(13):1336–45.CrossRefGoogle Scholar
  14. 14.
    Becker A, Leber A, Becker C, Knez A. Predictive value of coronary calcifications for future cardiac events in asymptomatic individuals. Am Heart J. 2008;155(1):154–60.CrossRefPubMedGoogle Scholar
  15. 15.
    Erbel R, Mohlenkamp S, Moebus S, Schmermund A, Lehmann N, Stang A, Dragano N, Gronemeyer D, Seibel R, Kalsch H, Brocker-Preuss M, Mann K, Siegrist J, Jockel KH. Coronary risk stratification, discrimination, and reclassification improvement based on quantification of subclinical coronary atherosclerosis: the Heinz Nixdorf Recall study. J Am Coll Cardiol. 2010;56(17):1397–406.CrossRefGoogle Scholar
  16. 16.
    Polonsky TS, McClelland RL, Jorgensen NW, Bild DE, Burke GL, Guerci AD, Greenland P. Coronary artery calcium score and risk classification for coronary heart disease prediction. JAMA. 2010;303(16):1610–6.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Elias-Smale SE, Proenca RV, Koller MT, Kavousi M, van Rooij FJ, Hunink MG, Steyerberg EW, Hofman A, Oudkerk M, Witteman JC. Coronary calcium score improves classification of coronary heart disease risk in the elderly: the Rotterdam study. J Am Coll Cardiol. 2010;56(17):1407–14.CrossRefGoogle Scholar
  18. 18.
    De Backer G, Ambrosioni E, Borch-Johnsen K, Brotons C, Cifkova R, Dallongeville J, Ebrahim S, Faergeman O, Graham I, Mancia G, Manger Cats V, Orth-Gomer K, Perk J, Pyorala K, Rodicio JL, Sans S, Sansoy V, Sechtem U, Silber S, Thomsen T, Wood D. European guidelines on cardiovascular disease prevention in clinical practice. Third joint task force of European and other societies on cardiovascular disease prevention in clinical practice. Eur Heart J. 2003;24(17):1601–10.CrossRefPubMedGoogle Scholar
  19. 19.
    Budoff MJ, Achenbach S, Blumenthal RS, Carr JJ, Goldin JG, Greenland P, Guerci AD, Lima JA, Rader DJ, Rubin GD, Shaw LJ, Wiegers SE. Assessment of coronary artery disease by cardiac computed tomography: a scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology. Circulation. 2006;114(16):1761–91.CrossRefPubMedGoogle Scholar
  20. 20.
    National Cholesterol Education Program, National Heart, Lung, and Blood Institute, National Institutes of Health. Third report of the expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (ATP III final report). 2002. Available at: https://www.nhlbi.nih.gov/files/docs/resources/heart/atp-3-cholesterol-full-report.pdf. Accessed 29 Oct 2016.
  21. 21.
    Raggi P, Callister TQ, Cooil B, He ZX, Lippolis NJ, Russo DJ, Zelinger A, Mahmarian JJ. Identification of patients at increased risk of first unheralded acute myocardial infarction by electron-beam computed tomography. Circulation. 2000;101(8):850–5.CrossRefPubMedGoogle Scholar
  22. 22.
    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.CrossRefPubMedGoogle Scholar
  23. 23.
    Kalia NK, Miller LG, Nasir K, Blumenthal RS, Agrawal N, Budoff MJ. Visualizing coronary calcium is associated with improvements in adherence to statin therapy. Atherosclerosis. 2006;185(2):394–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Rozanski A, Gransar H, Shaw LJ, Kim J, Miranda-Peats L, Wong ND, Rana JS, Orakzai R, Hayes SW, Friedman JD, Thomson LE, Polk D, Min J, Budoff MJ, Berman DS. Impact of coronary artery calcium scanning on coronary risk factors and downstream testing the EISNER (Early Identification of Subclinical Atherosclerosis by Noninvasive Imaging Research) prospective randomized trial. J Am Coll Cardiol. 2011;57(15):1622–32.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, Goldberg AC, Gordon D, Levy D, Lloyd-Jones DM, McBride P, Schwartz JS, Shero ST, Smith SC Jr, Watson K, Wilson PW. 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 Pt B):2889–934.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Hecht HS, Shaw LJ, Chandrashekhar Y, Narula J. Coronary artery calcium and shared decision making. JACC Cardiovasc Imaging. 2016;9(5):637–9.CrossRefPubMedGoogle Scholar
  27. 27.
    Mortensen MB, Fuster V, Muntendam P, Mehran R, Baber U, Sartori S, Falk E. A simple disease-guided approach to personalize ACC/AHA-recommended statin allocation in elderly people: the BioImage Study. J Am Coll Cardiol. 2016;68(9):881–91.CrossRefPubMedGoogle Scholar
  28. 28.
    Nasir K, Budoff MJ, Wong ND, Scheuner M, Herrington D, Arnett DK, Szklo M, Greenland P, Blumenthal RS. Family history of premature coronary heart disease and coronary artery calcification: Multi-Ethnic Study of Atherosclerosis (MESA). Circulation. 2007;116(6):619–26.CrossRefPubMedGoogle Scholar
  29. 29.
    He ZX, Hedrick TD, Pratt CM, Verani MS, Aquino V, Roberts R, Mahmarian JJ. Severity of coronary artery calcification by electron beam computed tomography predicts silent myocardial ischemia. Circulation. 2000;101(3):244–51.CrossRefPubMedGoogle Scholar
  30. 30.
    Berman DS, Wong ND, Gransar H, Miranda-Peats R, Dahlbeck J, Hayes SW, Friedman JD, Kang X, Polk D, Hachamovitch R, Shaw L, Rozanski A. Relationship between stress-induced myocardial ischemia and atherosclerosis measured by coronary calcium tomography. J Am Coll Cardiol. 2004;44(4):923–30.CrossRefGoogle Scholar
  31. 31.
    Garrison FH. On Thomas Sydenham (1624–1689). Bull N Y Acad Med. 1928;4:993.Google Scholar
  32. 32.
    Hoff JA, Chomka EV, Krainik AJ, Daviglus M, Rich S, Kondos GT. Age and gender distributions of coronary artery calcium detected by electron beam tomography in 35,246 adults. Am J Cardiol. 2001;87(12):1335–9.CrossRefGoogle Scholar
  33. 33.
    Vliegenthart R, Oudkerk M, Hofman A, Oei HH, van Dijck W, van Rooij FJ, Witteman JC. Coronary calcification improves cardiovascular risk prediction in the elderly. Circulation. 2005;112(4):572–7.CrossRefGoogle Scholar
  34. 34.
    Sirineni GK, Raggi P, Shaw LJ, Stillman AE. Calculation of coronary age using calcium scores in multiple ethnicities. Int J Cardiovasc Imaging. 2008;24(1):107–11.CrossRefGoogle Scholar
  35. 35.
    Shaw LJ, Raggi P, Berman DS, Callister TQ. Coronary artery calcium as a measure of biologic age. Atherosclerosis. 2006;188(1):112–9.CrossRefGoogle Scholar
  36. 36.
    Valenti V, Hartaigh BO, Heo R, Cho I, Schulman-Marcus J, Gransar H, Truong QA, Shaw LJ, Knapper J, Kelkar AA, Sandesara P, Lin FY, Sciarretta S, Chang HJ, Callister TQ, Min JK. A 15-year warranty period for asymptomatic individuals without coronary artery calcium: a prospective follow-up of 9,715 individuals. JACC Cardiovasc Imaging. 2015;8(8):900–9.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Raggi P, Gongora MC, Gopal A, Callister TQ, Budoff M, Shaw LJ. Coronary artery calcium to predict all-cause mortality in elderly men and women. J Am Coll Cardiol. 2008;52(1):17–23.CrossRefGoogle Scholar
  38. 38.
    Margolis JR, Kannel WS, Feinleib M, Dawber TR, McNamara PM. Clinical features of unrecognized myocardial infarction--silent and symptomatic. Eighteen year follow-up: the Framingham study. Am J Cardiol. 1973;32(1):1–7.CrossRefGoogle Scholar
  39. 39.
    Miller TD, Rajagopalan N, Hodge DO, Frye RL, Gibbons RJ. Yield of stress single-photon emission computed tomography in asymptomatic patients with diabetes. Am Heart J. 2004;147(5):890–6.CrossRefGoogle Scholar
  40. 40.
    Nesto RW, Phillips RT, Kett KG, Hill T, Perper E, Young E, Leland OS Jr. Angina and exertional myocardial ischemia in diabetic and nondiabetic patients: assessment by exercise thallium scintigraphy. Ann Intern Med. 1988;108(2):170–5.CrossRefGoogle Scholar
  41. 41.
    Bax JJ, Young LH, Frye RL, Bonow RO, Steinberg HO, Barrett EJ. Screening for coronary artery disease in patients with diabetes. Diabetes Care. 2007;30(10):2729–36.CrossRefGoogle Scholar
  42. 42.
    Iwasaki K, Matsumoto T, Aono H, Furukawa H, Samukawa M. Prevalence of subclinical atherosclerosis in asymptomatic diabetic patients by 64-slice computed tomography. Coron Artery Dis. 2008;19(3):195–201.CrossRefGoogle Scholar
  43. 43.
    Raggi P, Shaw LJ, Berman DS, Callister TQ. Prognostic value of coronary artery calcium screening in subjects with and without diabetes. J Am Coll Cardiol. 2004;43(9):1663–9.CrossRefGoogle Scholar
  44. 44.
    Elkeles RS, Godsland IF, Feher MD, Rubens MB, Roughton M, Nugara F, Humphries SE, Richmond W, Flather MD. Coronary calcium measurement improves prediction of cardiovascular events in asymptomatic patients with type 2 diabetes: the PREDICT study. Eur Heart J. 2008;29(18):2244–51.CrossRefGoogle Scholar
  45. 45.
    Anand DV, Lim E, Lahiri A, Bax JJ. The role of non-invasive imaging in the risk stratification of asymptomatic diabetic subjects. Eur Heart J. 2006;27(8):905–12.CrossRefGoogle Scholar
  46. 46.
    Anand DV, Lim E, Hopkins D, Corder R, Shaw LJ, Sharp P, Lipkin D, Lahiri A. Risk stratification in uncomplicated type 2 diabetes: prospective evaluation of the combined use of coronary artery calcium imaging and selective myocardial perfusion scintigraphy. Eur Heart J. 2006;27(6):713–21.CrossRefGoogle Scholar
  47. 47.
    Wong ND, Rozanski A, Gransar H, Miranda-Peats R, Kang X, Hayes S, Shaw L, Friedman J, Polk D, Berman DS. Metabolic syndrome and diabetes are associated with an increased likelihood of inducible myocardial ischemia among patients with subclinical atherosclerosis. Diabetes Care. 2005;28(6):1445–50.CrossRefGoogle Scholar
  48. 48.
    Budoff MJ, Raggi P, Beller GA, Berman DS, Druz RS, Malik S, Rigolin VH, Weigold WG, Soman P. Noninvasive cardiovascular risk assessment of the asymptomatic diabetic patient: the Imaging Council of the American College of Cardiology. JACC Cardiovasc Imaging. 2016;9(2):176–92.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Shaw LJ, Miller DD, Romeis JC, Kargl D, Younis LT, Chaitman BR. Gender differences in the noninvasive evaluation and management of patients with suspected coronary artery disease. Ann Intern Med. 1994;120(7):559–66.CrossRefGoogle Scholar
  50. 50.
    Mosca L, Grundy SM, Judelson D, King K, Limacher M, Oparil S, Pasternak R, Pearson TA, Redberg RF, Smith SC Jr, Winston M, Zinberg S. AHA/ACC scientific statement: consensus panel statement. Guide to preventive cardiology for women. American Heart Association/American College of Cardiology. J Am Coll Cardiol. 1999;33(6):1751–5.CrossRefGoogle Scholar
  51. 51.
    Vaccarino V, Abramson JL, Veledar E, Weintraub WS. Sex differences in hospital mortality after coronary artery bypass surgery: evidence for a higher mortality in younger women. Circulation. 2002;105(10):1176–81.CrossRefGoogle Scholar
  52. 52.
    Vaccarino V, Parsons L, Every NR, Barron HV, Krumholz HM. Sex-based differences in early mortality after myocardial infarction. National Registry of Myocardial Infarction 2 Participants. N Engl J Med. 1999;341(4):217–25.CrossRefGoogle Scholar
  53. 53.
    Michos ED, Nasir K, Braunstein JB, Rumberger JA, Budoff MJ, Post WS, Blumenthal RS. Framingham risk equation underestimates subclinical atherosclerosis risk in asymptomatic women. Atherosclerosis. 2006;184(1):201–6.CrossRefGoogle Scholar
  54. 54.
    Kelkar AA, Schultz WM, Khosa F, Schulman-Marcus J, O’Hartaigh BW, Gransar H, Blaha MJ, Knapper JT, Berman DS, Quyyumi A, Budoff MJ, Callister TQ, Min JK, Shaw LJ. Long-term prognosis after coronary artery calcium scoring among low-intermediate risk women and men. Circ Cardiovasc Imaging. 2016;9(4):e003742.CrossRefGoogle Scholar
  55. 55.
    Lakoski SG, Greenland P, Wong ND, Schreiner PJ, Herrington DM, Kronmal RA, Liu K, Blumenthal RS. Coronary artery calcium scores and risk for cardiovascular events in women classified as “low risk” based on Framingham risk score: the multi-ethnic study of atherosclerosis (MESA). Arch Intern Med. 2007;167(22):2437–42.CrossRefGoogle Scholar
  56. 56.
    Kavousi M, Desai CS, Ayers C, Blumenthal RS, Budoff MJ, Mahabadi AA, Ikram MA, van der Lugt A, Hofman A, Erbel R, Khera A, Geisel MH, Jockel KH, Lehmann N, Hoffmann U, O’Donnell CJ, Massaro JM, Liu K, Mohlenkamp S, Ning H, Franco OH, Greenland P. Prevalence and Prognostic Implications of Coronary Artery Calcification in Low-Risk Women: A Meta-analysis. JAMA. 2016;316(20):2126–34.  https://doi.org/10.1001/jama.2016.17020.CrossRefGoogle Scholar
  57. 57.
    Bellasi A, Lacey C, Taylor AJ, Raggi P, Wilson PW, Budoff MJ, Vaccarino V, Shaw LJ. Comparison of prognostic usefulness of coronary artery calcium in men versus women (results from a meta- and pooled analysis estimating all-cause mortality and coronary heart disease death or myocardial infarction). Am J Cardiol. 2007;100(3):409–14.CrossRefGoogle Scholar
  58. 58.
    Baber U, de Lemos JA, Khera A, McGuire DK, Omland T, Toto RD, Hedayati SS. Non-traditional risk factors predict coronary calcification in chronic kidney disease in a population-based cohort. Kidney Int. 2008;73(5):615–21.CrossRefGoogle Scholar
  59. 59.
    Bursztyn M, Motro M, Grossman E, Shemesh J. Accelerated coronary artery calcification in mildly reduced renal function of high-risk hypertensives: a 3-year prospective observation. J Hypertens. 2003;21(10):1953–9.CrossRefGoogle Scholar
  60. 60.
    Sigrist M, Bungay P, Taal MW, McIntyre CW. Vascular calcification and cardiovascular function in chronic kidney disease. Nephrol Dial Transplant. 2006;21(3):707–14.CrossRefGoogle Scholar
  61. 61.
    Block GA, Raggi P, Bellasi A, Kooienga L, Spiegel DM. Mortality effect of coronary calcification and phosphate binder choice in incident hemodialysis patients. Kidney Int. 2007;71(5):438–41.CrossRefGoogle Scholar
  62. 62.
    Raggi P, Boulay A, Chasan-Taber S, Amin N, Dillon M, Burke SK, Chertow GM. Cardiac calcification in adult hemodialysis patients. A link between end-stage renal disease and cardiovascular disease? J Am Coll Cardiol. 2002;39(4):695–701.CrossRefGoogle Scholar
  63. 63.
    Matsuoka M, Iseki K, Tamashiro M, Fujimoto N, Higa N, Touma T, Takishita S. Impact of high coronary artery calcification score (CACS) on survival in patients on chronic hemodialysis. Clin Exp Nephrol. 2004;8(1):54–8.CrossRefGoogle Scholar
  64. 64.
    Shimoyama Y, Tsuruta Y, Niwa T. Coronary artery calcification score is associated with mortality in Japanese hemodialysis patients. J Ren Nutr. 2012;22(1):139–42.CrossRefGoogle Scholar
  65. 65.
    Goodman WG, Goldin J, Kuizon BD, Yoon C, Gales B, Sider D, Wang Y, Chung J, Emerick A, Greaser L, Elashoff RM, Salusky IB. Coronary-artery calcification in young adults with end-stage renal disease who are undergoing dialysis. N Engl J Med. 2000;342(20):1478–83.CrossRefGoogle Scholar
  66. 66.
    Oh J, Wunsch R, Turzer M, Bahner M, Raggi P, Querfeld U, Mehls O, Schaefer F. Advanced coronary and carotid arteriopathy in young adults with childhood-onset chronic renal failure. Circulation. 2002;106(1):100–5.CrossRefGoogle Scholar
  67. 67.
    Wang AY, Wang M, Woo J, Lam CW, Li PK, Lui SF, Sanderson JE. Cardiac valve calcification as an important predictor for all-cause mortality and cardiovascular mortality in long-term peritoneal dialysis patients: a prospective study. J Am Soc Nephrol. 2003;14(1):159–68.CrossRefGoogle Scholar
  68. 68.
    Chertow GM, Raggi P, Chasan-Taber S, Bommer J, Holzer H, Burke SK. Determinants of progressive vascular calcification in haemodialysis patients. Nephrol Dial Transplant. 2004;19(6):1489–96.CrossRefGoogle Scholar
  69. 69.
    Chertow GM, Burke SK, Raggi P. Sevelamer attenuates the progression of coronary and aortic calcification in hemodialysis patients. Kidney Int. 2002;62(1):245–52.CrossRefGoogle Scholar
  70. 70.
    Guerin AP, London GM, Marchais SJ, Metivier F. Arterial stiffening and vascular calcifications in end-stage renal disease. Nephrol Dial Transplant. 2000;15(7):1014–21.CrossRefPubMedGoogle Scholar
  71. 71.
    Block GA, Spiegel DM, Ehrlich J, Mehta R, Lindbergh J, Dreisbach A, Raggi P. Effects of sevelamer and calcium on coronary artery calcification in patients new to hemodialysis. Kidney Int. 2005;68(4):1815–24.CrossRefPubMedGoogle Scholar
  72. 72.
    Di Iorio B, Bellasi A, Russo D. Mortality in kidney disease patients treated with phosphate binders: a randomized study. Clin J Am Soc Nephrol. 2012;7(3):487–93.CrossRefPubMedGoogle Scholar
  73. 73.
    Di Iorio B, Molony D, Bell C, Cucciniello E, Bellizzi V, Russo D, Bellasi A. Sevelamer versus calcium carbonate in incident hemodialysis patients: results of an open-label 24-month randomized clinical trial. Am J Kidney Dis. 2013;62(4):771–8.CrossRefPubMedPubMedCentralGoogle Scholar
  74. 74.
    Jamal SA, Vandermeer B, Raggi P, Mendelssohn DC, Chatterley T, Dorgan M, Lok CE, Fitchett D, Tsuyuki RT. Effect of calcium-based versus non-calcium-based phosphate binders on mortality in patients with chronic kidney disease: an updated systematic review and meta-analysis. Lancet. 2013;382(9900):1268–77.CrossRefPubMedPubMedCentralGoogle Scholar
  75. 75.
    Budoff MJ, Gul KM. Expert review on coronary calcium. Vasc Health Risk Manag. 2008;4(2):315–24.CrossRefPubMedPubMedCentralGoogle Scholar
  76. 76.
    Baumgart D, Schmermund A, Goerge G, Haude M, Ge J, Adamzik M, Sehnert C, Altmaier K, Groenemeyer D, Seibel R, Erbel R. Comparison of electron beam computed tomography with intracoronary ultrasound and coronary angiography for detection of coronary atherosclerosis. J Am Coll Cardiol. 1997;30(1):57–64.CrossRefPubMedPubMedCentralGoogle Scholar
  77. 77.
    Mintz GS, Pichard AD, Popma JJ, Kent KM, Satler LF, Bucher TA, Leon MB. Determinants and correlates of target lesion calcium in coronary artery disease: a clinical, angiographic and intravascular ultrasound study. J Am Coll Cardiol. 1997;29(2):268–74.CrossRefGoogle Scholar
  78. 78.
    Rumberger JA, Simons DB, Fitzpatrick LA, Sheedy PF, Schwartz RS. Coronary artery calcium area by electron-beam computed tomography and coronary atherosclerotic plaque area. A histopathologic correlative study. Circulation. 1995;92(8):2157–62.CrossRefGoogle Scholar
  79. 79.
    Shareghi S, Ahmadi N, Young E, Gopal A, Liu ST, Budoff MJ. Prognostic significance of zero coronary calcium scores on cardiac computed tomography. J Cardiovasc Computed Tomogr. 2007;1(3):155–9.CrossRefGoogle Scholar
  80. 80.
    Shaw LJ, Giambrone AE, Blaha MJ, Knapper JT, Berman DS, Bellam N, Quyyumi A, Budoff MJ, Callister TQ, Min JK. Long-term prognosis after coronary artery calcification testing in asymptomatic patients: a cohort study. Ann Intern Med. 2015;163(1):14–21.CrossRefPubMedGoogle Scholar
  81. 81.
    Cheng VY, Lepor NE, Madyoon H, Eshaghian S, Naraghi AL, Shah PK. Presence and severity of noncalcified coronary plaque on 64-slice computed tomographic coronary angiography in patients with zero and low coronary artery calcium. Am J Cardiol. 2007;99(9):1183–6.CrossRefPubMedGoogle Scholar
  82. 82.
    Valenti V, Hartaigh BO, Cho I, Schulman-Marcus J, Gransar H, Heo R, Truong QA, Shaw LJ, Knapper J, Kelkar AA, Sciarretta S, Chang HJ, Callister TQ, Min JK. Absence of coronary artery calcium identifies asymptomatic diabetic individuals at low near-term but not long-term risk of mortality: a 15-year follow-up study of 9715 patients. Circ Cardiovasc Imaging. 2016;9(2):e003528.CrossRefPubMedPubMedCentralGoogle Scholar
  83. 83.
    Groen JM, Greuter MJ, Schmidt B, Suess C, Vliegenthart R, Oudkerk M. The influence of heart rate, slice thickness, and calcification density on calcium scores using 64-slice multidetector computed tomography: a systematic phantom study. Investig Radiol. 2007;42(12):848–55.CrossRefGoogle Scholar
  84. 84.
    Horiguchi J, Matsuura N, Yamamoto H, Hirai N, Kiguchi M, Fujioka C, Kitagawa T, Kohno N, Ito K. Variability of repeated coronary artery calcium measurements by 1.25-mm- and 2.5-mm-thickness images on prospective electrocardiograph-triggered 64-slice CT. Eur Radiol. 2008;18(2):209–16.CrossRefPubMedGoogle Scholar
  85. 85.
    Horiguchi J, Yamamoto H, Hirai N, Akiyama Y, Fujioka C, Marukawa K, Fukuda H, Ito K. Variability of repeated coronary artery calcium measurements on low-dose ECG-gated 16-MDCT. AJR Am J Roentgenol. 2006;187(1):W1–6.CrossRefPubMedGoogle Scholar
  86. 86.
    Hokanson JE, MacKenzie T, Kinney G, Snell-Bergeon JK, Dabelea D, Ehrlich J, Eckel RH, Rewers M. Evaluating changes in coronary artery calcium: an analytic method that accounts for interscan variability. AJR Am J Roentgenol. 2004;182(5):1327–32.CrossRefPubMedGoogle Scholar
  87. 87.
    Shemesh J, Apter S, Stolero D, Itzchak Y, Motro M. Annual progression of coronary artery calcium by spiral computed tomography in hypertensive patients without myocardial ischemia but with prominent atherosclerotic risk factors, in patients with previous angina pectoris or healed acute myocardial infarction, and in patients with coronary events during follow-up. Am J Cardiol. 2001;87(12):1395–7.CrossRefPubMedGoogle Scholar
  88. 88.
    Becker A, Leber A, von Ziegler F, Becker C, Knez A. Comparison of progression of coronary calcium in postmenopausal women on versus not on estrogen/progestin therapy. Am J Cardiol. 2007;99(3):374–8.CrossRefPubMedGoogle Scholar
  89. 89.
    Budoff MJ, Chen GP, Hunter CJ, Takasu J, Agrawal N, Sorochinsky B, Mao S. Effects of hormone replacement on progression of coronary calcium as measured by electron beam tomography. J Womens Health (Larchmt). 2005;14(5):410–7.CrossRefGoogle Scholar
  90. 90.
    Budoff MJ, Raggi P. Coronary artery disease progression assessed by electron-beam computed tomography. Am J Cardiol. 2001;88(2A):46E–50E.CrossRefPubMedGoogle Scholar
  91. 91.
    Hsia J, Klouj A, Prasad A, Burt J, Adams-Campbell LL, Howard BV. Progression of coronary calcification in healthy postmenopausal women. BMC Cardiovasc Disord. 2004;4:21.CrossRefPubMedPubMedCentralGoogle Scholar
  92. 92.
    Raggi P, Cooil B, Shaw LJ, Aboulhson J, Takasu J, Budoff M, Callister TQ. Progression of coronary calcium on serial electron beam tomographic scanning is greater in patients with future myocardial infarction. Am J Cardiol. 2003;92(7):827–9.CrossRefPubMedGoogle Scholar
  93. 93.
    Rasouli ML, Nasir K, Blumenthal RS, Park R, Aziz DC, Budoff MJ. Plasma homocysteine predicts progression of atherosclerosis. Atherosclerosis. 2005;181(1):159–65.CrossRefPubMedGoogle Scholar
  94. 94.
    Yoon HC, Emerick AM, Hill JA, Gjertson DW, Goldin JG. Calcium begets calcium: progression of coronary artery calcification in asymptomatic subjects. Radiology. 2002;224(1):236–41.CrossRefPubMedGoogle Scholar
  95. 95.
    Sutton-Tyrrell K, Kuller LH, Edmundowicz D, Feldman A, Holubkov R, Givens L, Matthews KA. Usefulness of electron beam tomography to detect progression of coronary and aortic calcium in middle-aged women. Am J Cardiol. 2001;87(5):560–4.CrossRefPubMedGoogle Scholar
  96. 96.
    Kawakubo M, LaBree L, Xiang M, Doherty TM, Wong ND, Azen S, Detrano R. Race-ethnic differences in the extent, prevalence, and progression of coronary calcium. Ethn Dis. 2005;15(2):198–204.PubMedPubMedCentralGoogle Scholar
  97. 97.
    Wong ND, Nelson JC, Granston T, Bertoni AG, Blumenthal RS, Carr JJ, Guerci A, Jacobs DR Jr, Kronmal R, Liu K, Saad M, Selvin E, Tracy R, Detrano R. Metabolic syndrome, diabetes, and incidence and progression of coronary calcium: the Multiethnic Study of Atherosclerosis study. JACC Cardiovasc Imaging. 2012;5(4):358–66.CrossRefPubMedPubMedCentralGoogle Scholar
  98. 98.
    Cassidy AE, Bielak LF, Zhou Y, Sheedy PF 2nd, Turner ST, Breen JF, Araoz PA, Kullo IJ, Lin X, Peyser PA. Progression of subclinical coronary atherosclerosis: does obesity make a difference? Circulation. 2005;111(15):1877–82.CrossRefPubMedGoogle Scholar
  99. 99.
    Kronmal RA, McClelland RL, Detrano R, Shea S, Lima JA, Cushman M, Bild DE, Burke GL. Risk factors for the progression of coronary artery calcification in asymptomatic subjects: results from the Multi-Ethnic Study of Atherosclerosis (MESA). Circulation. 2007;115(21):2722–30.CrossRefPubMedGoogle Scholar
  100. 100.
    Raggi P, Cooil B, Ratti C, Callister TQ, Budoff M. Progression of coronary artery calcium and occurrence of myocardial infarction in patients with and without diabetes mellitus. Hypertension. 2005;46(1):238–43.CrossRefPubMedGoogle Scholar
  101. 101.
    Snell-Bergeon JK, Hokanson JE, Jensen L, MacKenzie T, Kinney G, Dabelea D, Eckel RH, Ehrlich J, Garg S, Rewers M. Progression of coronary artery calcification in type 1 diabetes: the importance of glycemic control. Diabetes Care. 2003;26(10):2923–8.CrossRefPubMedGoogle Scholar
  102. 102.
    Mehrotra R, Budoff M, Christenson P, Ipp E, Takasu J, Gupta A, Norris K, Adler S. Determinants of coronary artery calcification in diabetics with and without nephropathy. Kidney Int. 2004;66(5):2022–31.CrossRefPubMedGoogle Scholar
  103. 103.
    Min JK, Lin FY, Gidseg DS, Weinsaft JW, Berman DS, Shaw LJ, Rozanski A, Callister TQ. 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.CrossRefPubMedGoogle Scholar
  104. 104.
    Callister TQ, Raggi P, Cooil B, Lippolis NJ, Russo DJ. Effect of HMG-CoA reductase inhibitors on coronary artery disease as assessed by electron-beam computed tomography. N Engl J Med. 1998;339(27):1972–8.CrossRefPubMedGoogle Scholar
  105. 105.
    Budoff MJ, Lane KL, Bakhsheshi H, Mao S, Grassmann BO, Friedman BC, Brundage BH. Rates of progression of coronary calcium by electron beam tomography. Am J Cardiol. 2000;86(1):8–11.CrossRefPubMedGoogle Scholar
  106. 106.
    Raggi P, Davidson M, Callister TQ, Welty FK, Bachmann GA, Hecht H, Rumberger JA. Aggressive versus moderate lipid-lowering therapy in hypercholesterolemic postmenopausal women: Beyond Endorsed Lipid Lowering with EBT Scanning (BELLES). Circulation. 2005;112(4):563–71.CrossRefPubMedGoogle Scholar
  107. 107.
    Schmermund A, Achenbach S, Budde T, Buziashvili Y, Forster A, Friedrich G, Henein M, Kerkhoff G, Knollmann F, Kukharchuk V, Lahiri A, Leischik R, Moshage W, Schartl M, Siffert W, Steinhagen-Thiessen E, Sinitsyn V, Vogt A, Wiedeking B, Erbel R. Effect of intensive versus standard lipid-lowering treatment with atorvastatin on the progression of calcified coronary atherosclerosis over 12 months: a multicenter, randomized, double-blind trial. Circulation. 2006;113(3):427–37.CrossRefPubMedGoogle Scholar
  108. 108.
    Achenbach S, Ropers D, Pohle K, Leber A, Thilo C, Knez A, Menendez T, Maeffert R, Kusus M, Regenfus M, Bickel A, Haberl R, Steinbeck G, Moshage W, Daniel WG. Influence of lipid-lowering therapy on the progression of coronary artery calcification: a prospective evaluation. Circulation. 2002;106(9):1077–82.CrossRefPubMedGoogle Scholar
  109. 109.
    Henein M, Granasen G, Wiklund U, Schmermund A, Guerci A, Erbel R, Raggi P. High dose and long-term statin therapy accelerate coronary artery calcification. Int J Cardiol. 2015;184:581–6.CrossRefPubMedGoogle Scholar
  110. 110.
    Manson JE, Allison MA, Rossouw JE, Carr JJ, Langer RD, Hsia J, Kuller LH, Cochrane BB, Hunt JR, Ludlam SE, Pettinger MB, Gass M, Margolis KL, Nathan L, Ockene JK, Prentice RL, Robbins J, Stefanick ML. Estrogen therapy and coronary-artery calcification. N Engl J Med. 2007;356(25):2591–602.CrossRefPubMedGoogle Scholar
  111. 111.
    Raggi P, Callister TQ, Shaw LJ. Progression of coronary artery calcium and risk of first myocardial infarction in patients receiving cholesterol-lowering therapy. Arterioscler Thromb Vasc Biol. 2004;24(7):1272–7.CrossRefPubMedPubMedCentralGoogle Scholar
  112. 112.
    Budoff MJ, Hokanson JE, Nasir K, Shaw LJ, Kinney GL, Chow D, Demoss D, Nuguri V, Nabavi V, Ratakonda R, Berman DS, Raggi P. Progression of coronary artery calcium predicts all-cause mortality. JACC Cardiovasc Imaging. 2010;3(12):1229–36.CrossRefPubMedGoogle Scholar
  113. 113.
    Radford NB, DeFina LF, Barlow CE, Lakoski SG, Leonard D, Paixao AR, Khera A, Levine BD. Progression of CAC score and risk of incident CVD. JACC Cardiovasc Imaging. 2016;9(12):1420–9.CrossRefPubMedPubMedCentralGoogle Scholar
  114. 114.
    Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, Das SR, de Ferranti S, Despres JP, Fullerton HJ, Howard VJ, Huffman MD, Isasi CR, Jimenez MC, Judd SE, Kissela BM, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Magid DJ, McGuire DK, Mohler ER 3rd, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Rosamond W, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Woo D, Yeh RW, Turner MB. Heart disease and stroke statistics-2016 update: a report from the American Heart Association. Circulation. 2016;133(4):e38–360.Google Scholar
  115. 115.
    Blaha MJ, Budoff MJ, DeFilippis AP, Blankstein R, Rivera JJ, Agatston A, O’Leary DH, Lima J, Blumenthal RS, Nasir K. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  116. 116.
    Fazel R, Gerber TC, Balter S, Brenner DJ, Carr JJ, Cerqueira MD, Chen J, Einstein AJ, Krumholz HM, Mahesh M, McCollough CH, Min JK, Morin RL, Nallamothu BK, Nasir K, Redberg RF, Shaw LJ. Approaches to enhancing radiation safety in cardiovascular imaging: a scientific statement from the American Heart Association. Circulation. 2014;130(19):1730–48.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Nikolaos Alexopoulos
    • 1
  • Paolo Raggi
    • 2
  1. 1.Cardiovascular Imaging Unit, Radiology DepartmentEuroclinic Athens, SAAthensGreece
  2. 2.Mazankowski Alberta Heart Institute, Division of CardiologyUniversity of AlbertaEdmontonCanada

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