Abstract
Coronary artery calcium (CAC) has been advocated as one of the strongest cardiovascular risk prediction markers. It performs better across a wide range of Framingham risk categories (6%–10% and 10%–20% 10-year risk categories) and also helps in reclassifying the risk of these subjects into either higher or lower risk categories based on CAC scores. It also performs better among population subgroups where Framingham risk score does not perform well, especially young subjects, women, family history of premature coronary artery disease and ethnic differences in coronary risk. The absence of CAC is also associated with excellent prognosis, with 10-year event rate of 1%. Studies have also compared with other commonly used markers of cardiovascular disease risk such as Carotid intima-media thickness and highly sensitive C-reactive protein. CAC also performs better compared with carotid intima-media thickness and highly sensitive C-reactive protein in prediction of coronary heart disease and cardiovascular disease events. CAC scans are associated with relatively low radiation exposure (0.9–1.1 mSv) and provide information that can be used not only for risk stratification but also can be used to track the progression of atherosclerosis and the effects of statins.
Highlights
Atherosclerosis coronary artery disease is among the leading cause of morbidity and mortality in the Western world
Framingham risk scores (FRS), Reynolds risk score, highly sensitive C-reactive protein, carotid intima media thickness (CIMT) and coronary artery calcium (CAC) are among the various measures that can be used for screening of cardiovascular disease among asymptomatic population
The addition of CAC to FRS resulted in a superior discrimination for incident coronary heart disease (CHD) in the intermediate-risk groups compared to when thoracic aorta calcium (TAC), aortic valve calcification (AVC), mitral annular calcification (MAC), pericardial adipose tissue volume (PAT) and liver attenuation (LA) were added to FRS + CAC (0.024, 0.026, 0.019, 0.012 and 0.012, respectively)
Summary
Atherosclerosis coronary artery disease is among the leading cause of morbidity and mortality in the Western world. The shear burden of cardiovascular disease on healthcare costs is enormous, with an estimate of 475 billion US dollars spent in the year 2009 alone [1]. In order to drive the cost down, emphasis is on preventive measures and earlier detection of cardiovascular disease. Framingham risk scores (FRS), Reynolds risk score, highly sensitive C-reactive protein (hs-CRP), carotid intima media thickness (CIMT) and coronary artery calcium (CAC) are among the various measures that can be used for screening of cardiovascular disease among asymptomatic population. CAC score has emerged as one of the strongest risk prediction tools. It represents calcific atherosclerosis in the coronary arteries and correlates well with the overall burden of atherosclerosis in the coronary arteries. The current review article will compare CAC score with the remaining risk stratification tools
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