Abstract
Both American and European guidelines recommend coronary artery calcification (CAC) as a tool for screening asymptomatic individuals at intermediate risk for coronary heart disease (CHD). These recommendations are based on epidemiologic studies mostly in the United States. We review (1) the use of CAC in primary prevention of CHD in the United States, (2) epidemiologic studies of CAC in asymptomatic adults outside of the United States, and (3) international epidemiologic studies of CAC. This review will not consider clinical studies of CAC among patients or symptomatic individuals. US studies have shown that CAC is a strong independent predictor of CHD in both sexes among middle-aged and old age groups, various ethnic groups, and individuals with and without diabetes and that CAC plays an important role in reclassifying individuals from intermediate to high risk. Studies in Europe support these conclusions. The Electron-Beam Tomography, Risk Factor Assessment Among Japanese and US Men in the Post-World-War-II birth cohort (ERA JUMP) Study is the first international study to compare subclinical atherosclerosis, including CAC among Japanese, Japanese Americans, Koreans, and whites. It showed that as compared with whites, Japanese had lower levels of atherosclerosis, whereas Japanese Americans had similar or higher levels. CAC is being increasingly used as a screening tool for asymptomatic individuals in Europe and the United States. CAC is a powerful research tool, because it enables us to describe differences in atherosclerotic burden across populations. Such research could identify factors responsible for differences among populations, which may improve CHD prevention.
Highlights
Screening asymptomatic individuals for subclinical atherosclerosis is the subject of intensive research.[1]
Primary aims at baseline were: (1) to test the null hypothesis that there is no difference in CAC prevalence and carotid IMT levels among men aged 40 to 49 from 3 populations with different coronary heart disease (CHD) mortality but very similar traditional risk factor profiles, (2) to determine the relationship of risk factors to CAC and IMT within and across these population samples, and (3) to explore factors responsible for the difference in levels of subclinical atherosclerosis
The ERA JUMP Study, though it is much smaller than the Seven Countries Study, is a unique international population-based study of subclinical atherosclerosis, including CAC and IMT
Summary
Screening asymptomatic individuals for subclinical atherosclerosis is the subject of intensive research.[1].
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