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An Update on the Utility of Coronary Artery Calcium Scoring for Coronary Heart Disease and Cardiovascular Disease Risk Prediction

  • Coronary Heart Disease (S. Virani and S. Naderi, Section Editors)
  • Published:
Current Atherosclerosis Reports Aims and scope Submit manuscript

Abstract

Estimating cardiovascular disease (CVD) risk is necessary for determining the potential net benefit of primary prevention pharmacotherapy. Risk estimation relying exclusively on traditional CVD risk factors may misclassify risk, resulting in both undertreatment and overtreatment. Coronary artery calcium (CAC) scoring personalizes risk prediction through direct visualization of calcified coronary atherosclerotic plaques and provides improved accuracy for coronary heart disease (CHD) or CVD risk estimation. In this review, we discuss the most recent studies on CAC, which unlike historical studies, focus sharply on clinical application. We describe the MESA CHD risk calculator, a recently developed CAC-based 10-year CHD risk estimator, which can help guide preventive therapy allocation by better identifying both high- and low-risk individuals. In closing, we discuss calcium density, regional distribution of CAC, and extra-coronary calcification, which represent the future of CAC and CVD risk assessment research and may lead to further improvements in risk prediction.

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Abbreviations

ACC/AHA:

American College of Cardiology/American Heart Association

ASCVD:

Atherosclerotic cardiovascular disease

CAC:

Coronary artery calcium

CAC = 0:

Coronary artery calcium score of zero

CHD:

Coronary heart disease

CTA:

Computed tomographic angiography

CVD:

Cardiovascular disease

DHS:

Dallas Heart Study

ECC:

Extra-coronary calcification

HRS:

Heinz-Nixdorf Recall Study

MESA:

Multiethnic Study of Atherosclerosis

PCE:

Pooled Cohort Equations

cPCE:

Recalibrated Pooled Cohort Equations

ROC:

Receiver-operator characteristic

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

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Authors and Affiliations

  1. Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, 21287, USA

    Sina Kianoush, Mahmoud Al Rifai, Miguel Cainzos-Achirica, Priya Umapathi, Roger S. Blumenthal, Khurram Nasir & Michael J. Blaha

  2. Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, 21287, USA

    Miguel Cainzos-Achirica & Michael J. Blaha

  3. Blalock 524 D1, 600 N. Wolfe St., Baltimore, MD, 21287, USA

    Michael J. Blaha

  4. Aetna Foundation, Hartford, CT, USA

    Garth Graham

  5. University of Connecticut School of Medicine, Farmington, CT, USA

    Garth Graham

  6. Center for Healthcare Advancement and Outcomes & Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA

    Khurram Nasir

  7. Department of Epidemiology, Robert Stempel College of Public Health, Miami, FL, USA

    Khurram Nasir

  8. Department of Medicine, Herbert Wertheim College of Medicine, Miami, FL, USA

    Khurram Nasir

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  1. Sina Kianoush
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Sina Kianoush, Mahmoud Al Rifai, Miguel Cainzos-Achirica, Priya Umapathi, Garth Graham, Roger S. Blumenthal, and Khurram Nasir declare that they have no conflict of interest.

Michael J. Blaha declares grants from NIH/NHLBI, American Heart Association, Aetna Foundation, grants and personal fees from the FDA, and personal fees for Advisory Board work with Pfizer, Novartis, Aralez Pharmaceuticals, Luitpold Pharmaceuticals, and ISIS Pharmaceuticals.

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Kianoush, S., Rifai, M.A., Cainzos-Achirica, M. et al. An Update on the Utility of Coronary Artery Calcium Scoring for Coronary Heart Disease and Cardiovascular Disease Risk Prediction. Curr Atheroscler Rep 18, 13 (2016). https://doi.org/10.1007/s11883-016-0565-6

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