Role of coronary artery calcium in cardiovascular risk assessment

Abstract

Coronary artery disease (CAD) is associated with substantial morbidity and mortality worldwide. Despite many advances in prevention and therapy for CAD, a third to one-half of cardiovascular events occur in those with no prior symptoms. Assessing subclinical disease using coronary artery calcium (CAC) has been shown to provide additional risk stratification and to improve prediction of cardiovascular events over traditional strategies such as the Framingham Risk Score. In this review, we aim to cover the current data available on utilization of CAC as a tool in the general population as well as in targeted subgroups such as those with diabetes and metabolic syndrome. For this review, the authors performed thorough Pubmed and Medline searches using keywords coronary artery calcification, X-ray computed tomography, multidetector computed tomography, CAD, diabetes mellitus and metabolic syndrome. Based on the authors’ review of literature, they believe that CAC is an excellent risk stratification imaging modality, especially in patients with diabetes and metabolic syndrome; behavioral changes in patients and therapeutic interventions based on CAC scoring are cost-effective.

Keywords::

• calcium
• coronary artery calcification
• coronary artery disease
• diabetes mellitus
• metabolic syndrome
• multidetector computed tomography
• risk
• X-ray computed tomography

Financial & competing interests disclosure

ND Wong is a consultant for Re-Engineering Healthcare, Inc. and receives research funding through the University of California, CA, USA from Bristol Myers-Squibb. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• A third to a half of all cardiovascular disease-related events occur in people with no prior symptoms.

• Diabetes is considered a coronary artery disease (CAD) equivalent when estimating risk for future CAD events; however people with diabetes represent a spectrum of risk for CAD.

• Coronary artery calcium scoring provides additional risk stratification and improve prediction of cardiovascular events over traditional risk stratification strategies.

• Coronary artery calcium further stratifies patients with diabetes and metabolic syndrome to determine appropriate intensity of therapeutic approaches.

Notes