Commentary: Use of EBCT in epidemiological studies: the effect of noise and body size on coronary calcium scores

Abstract

Electron beam computerized tomography (EBCT) is a noninvasive scanning technique that allows both detection and quantification of coronary artery calcium. Although only 20% of atherosclerotic plaque is calcified, the presence of coronary artery calcium in post-mortem specimens is a marker for the presence of atherosclerotic plaque and the quantity of calcium correlates with total atheroma burden. 1 Available for over a decade, EBCT has been used extensively in the clinical assessment of patients at high risk of coronary heart disease, predominantly in the US. 2 Another promising application for EBCT is as a screening tool for coronary atheroma in epidemiological studies, particularly in young asymptomatic cohorts. Although fewer in number than those studies utilizing EBCT in clinical settings, there have been a number of recent reports of epidemiological studies using EBCT in participants with no evidence of pre-existing coronary heart disease. 3‐6 Sekikawa et al. report on such a study in this issue, where they used EBCT to address the question of whether men born after the Second World War in America and Japan show differences in levels of atherosclerosis taking into account differences in cardiovascular risk. 7 The validity of EBCT has been tested primarily in clinical patients who have high pre-test probability of disease. 2 The validity of the technique in populations with a low prevalence of disease has not been systematically studied, but there are indications that it is less robust in these groups.