Elevated Coronary Artery Calcium Score Research Articles

Abstract 10256: Presence, but Not Severity, of Coronary Artery Calcium Predicts Covid-19 Mortality

Introduction: Coronary artery calcium score (CACS) is a known predictor of cardiac events, however its association with inpatient mortality in COVID-19 infection remains unknown. Hypothesis: We hypothesized that elevated CACS is associated with increased mortality in inpatient patients with COVID-19. Methods: Inpatients with COVID-19 between March and May, 2020 at a single center were identified. All patients had a non-contrast chest CT during admission, and CACS and Multi-Ethnic Study of Atherosclerosis (MESA) percentile were retrospectively measured. Patients were grouped in quartiles: no CACS (0 AU), mild CACS (1-99 AU), moderate CACS (100-399 AU), and severe ( > 400 AU). Inpatient mortality was compared between groups using logistic regression adjusted for age and troponin level. Results: One hundred thirty-nine patients were included with 107 (80%) surviving to discharge. Eighty-two patients self-identified as black or African American (59%) and 66 were female sex at birth (47%). The mean CACS for the survivors was 319 AU and 406 AU for non-survivors (p = 0.02). The mean MESA percentile for survivors and non-survivors was 41% and 60%, respectively (p = 0.03). Fifty-nine patients had no CACS, 19 had mild CACS, 28 had moderate CACS, and 33 had severe CACS. Fifty-three of the no CACS group survived (89%), 13 of the mild group survived (68%), 17 of the moderate group survived (60%), and 24 of the severe group survived (73%). After adjustment for age and troponin level, CACS > 0 AU versus those with CACS of 0 AU had 4-fold higher odds of mortality (OR 4.0, 95%CI 1.3 - 12, p= 0.02). However, there was no significant increased odds of death within higher quartiles of CACS (OR 1.4, 95%CI 1.0 - 2.1, p=0.08). Conclusion: The presence of coronary artery calcium positively correlates with inpatient COVID-19 mortality, even after accounting for age and myocardial injury. Severity of CACS, however, is not associated with mortality.

The association between periodontitis and cardiovascular risks in asymptomatic healthy patients

BackgroundPeriodontitis is a chronic multifactorial inflammatory disease of the supportive tissues of the teeth. Pathophysiological evidence suggests a possible common inflammatory background between periodontitis and cardiovascular diseases (CVD). Pathological and epidemiological associations between these two diseases have been presented, but are still debated. This study aimed to investigate the association between the inflammatory burden of periodontitis and the presence and extent of coronary calcification. Secondary aims were to study other cardiovascular parameters and cardiovascular risk predictors in relation to periodontitis and dental health. MethodsHealthy periodontitis or non-periodontitis patients 45–70 years of age were included in a prospective cross-sectional study. Full-mouth examinations were performed by a periodontist to determine their Periodontal Inflamed Surface Area (PISA) score and other dental parameters. To assess the cardiovascular conditions, Coronary Artery Calcium (CAC) scores, endothelial function assessments by the EndoPAT ™, and several physical and biochemical examinations were performed. ResultsSeventy-one patients were included. Elevated CAC scores and endothelial dysfunction were not significantly related to PISA or dental health. PISA was significantly related to the Framingham and Reynolds CVD risk predictors, but were no longer significant after correction for confounders. The same applied to the significant relations between tooth loss, dental plaque and bleeding scores and the CVD risk predictors. ConclusionsPeriodontitis is associated with increased CVD risk, but is not an independent risk factor. This link is still important to make to bridge the gap between dentistry and general medicine and to identify patients at risk for CVD in an earlier stage.

Physical Activity and Elevated Coronary Artery Calcium Scores

Coronary artery calcium (CAC) can help to predict risk for adverse cardiovascular (CV) events. In this analysis of a large South Korean cohort of

Coronary calcium in autoimmune diseases: A systematic literature review and meta-analysis

Background and aimsAutoimmune diseases (AID) share various clinical signs and symptoms and pathophysiological mechanisms including the increased risk of cardiovascular disease. The coronary artery calcium score (CACS) is potentially useful in improving the cardiovascular risk assessment. The aim of this study was to evaluate CACS in six AIDs analyzed as a group compared with controls through a systematic literature review (SLR) and meta-analysis. MethodsA literature search (Medline/OVID, Lilacs, Embase, and Cochrane/OVID) up to January 6, 2021 was made (PROSPERO CRD42020197182). Observational studies (patients with six AIDs: rheumatoid arthritis [RA], systemic lupus erythematosus [SLE], Sjögren's syndrome, systemic sclerosis, dermatopolymyositis, and antiphospholipid syndrome) compared with controls were included. CACS, reported in Agatston units, was the primary outcome in both groups. Mean differences and a random-effects model (DerSimonian and Laird) were calculated. ResultsNineteen articles were meta-analyzed (4568 subjects: 2142 AID and 2426 controls). Mean age was 48.1 and 44.2 years, respectively and 75.6% and 84.9% were women, respectively. Of cases, 52.9% had RA, 44.4% SLE and 2.7% had systemic sclerosis. The pooled analysis showed a higher CACS in patients with AIDs (7.42; 95% CI 1.79 to 13.05; chi2-p = 0.01) compared with controls. Meta-regression models showed that age in cases and controls reduced the difference in CACS between groups (p < 0.05), HDL had an inverse relationship (p = 0.04), and CRP levels had a directly proportional relationship with CACS in cases (p = 0.036). ConclusionsThe quantitative results of this meta-analysis suggest that CACS is higher in patients with AID, possibly due to chronic exposure to pro-inflammatory molecules. These results have clinical implications since the finding of highly elevated CACS in patients with AID will enable physicians and researchers to develop a risk stratification model that includes CACS as one of the screening tools for detecting coronary atherosclerosis in these patients.

Alcohol-related cirrhosis is associated with high coronary artery calcium scores in patients undergoing evaluation for orthotopic liver transplantation.

Coronary artery disease is a major cause of morbidity and mortality in liver transplant patients. Coronary artery calcium (CAC) score has been used to evaluate the risk of CAD in non-cirrhotic patients. However, its significance in cirrhotic patients is unknown. This study aimed to identify factors associated with elevated CAC scores in patients with end-stage liver disease undergoing liver transplant evaluation. We retrospectively reviewed all patients who underwent liver transplantation evaluation and had coronary CT scan between January 2015 and December 2018. Patients with prior history of CAD were excluded. CAC score was calculated based on the method described by Agatston. Sixty-two patients were included. 37.1% had alcohol-related liver disease and 27.4% had NASH cirrhosis. Mean CAC score was 261.1±SD, 463.84. Alcohol-related liver disease, male gender, and hypertension were significantly associated with CAC score >100 and only alcohol-related liver disease was associated with CAC score >300. In logistic regression, patients with alcohol-related liver disease had more than sixfold increase in risk of having CAC scores >100 and 300 (OR 6.14, and 6.70, respectively). Alcohol-related liver disease, male gender, and hypertension were significantly associated with an increased CAC score >100. However, alcohol-related liver disease was the only factor associated with CAC score >300.

Abstract P706: Age and Elevated Coronary Artery Calcium Score as a Predictor of Cerebral Ischemic Events

Introduction: Coronary artery calcium (CAC) score is a good predictor of coronary plaque burden and cardiovascular events, however its role in ischemic stroke and transient ischemic attacks (TIA) has been sparsely studied. Methods: Participants age ≥18 years with heart screen done from Nov 2008- Feb 2019 were selected and were assessed for documented Ischemic events (Ischemic stroke and TIA) after their heart screen. Only the most recent heart screen per person was considered. Patients were further divide into two groups based on their age. Comparisons between the two age groups was done using chi-square for categorical variables. Logistic regression was used to assess age and CAC as predictors of ischemic events and ROC curves were formed. Results: A total of 330896 individuals were included in the study over a span of 10 years, of which 53.9% were females. 894 (0.2%) patients were observed to have a documented diagnosis of ischemic stroke or TIA. Older patients (Age ≥50) were found to have significantly higher percentage of ischemic events as compared to young patients (3.5% vs 0.9%, p&lt;0.001), which was also observed among various CAC groups. There was also a significant difference in distribution of CAC where older patients had higher CAC even when splitting the cohort into distinct CAC categories (P &lt;0.001). On regression analysis elevated CAC and age were found to be a good predictors of ischemic events. Predictability of cerebrovascular ischemic events was significantly higher when elevated CAC score and patient age were considered together as compared age and CAC alone (P&lt;0.001). Conclusion: Elevated coronary artery calcium score and age are a good predictor of ischemic stroke and TIA.

Relationship between Retinal Nerve Fiber Layer Defects and Coronary Artery Calcium Score in Patients at Risk for Cardiovascular Disease

Background: Noninvasive fundus imaging may provide useful information on blood vessels. This study investigated the relationship between localized retinal nerve fiber layer defects (RNFLDs) and vascular biomarkers.Methods: This study included 1,316 participants without cardiovascular disease who were registered in a cardiovascular high-risk cohort. Examined vascular biomarkers included central hemodynamics, carotid-femoral pulse wave velocity (cfPWV), left ventricular hypertrophy (LVH) on electrocardiogram, and coronary artery calcium score (CACS). Fundus photography and optical coherence tomography were used to evaluate RNFLDs. The associations between RNFLDs and established high-risk cutoff points for each biomarker (central blood pressure [BP] ≥125/80 mmHg, central pulse pressure [PP] ≥50 mmHg, cfPWV ≥10 m/s, presence of LVH, and CACS ≥300) were assessed.Results: RNFLD was identified in 394 participants (29.9%) who had higher fasting glucose level, lower renal function, and higher BP than those without RNFLDs. Additionally, central BP, central PP, cfPWV, CACS, and the percentage of subjects with LVH were higher in the RNFLD group. After adjusting for confounders, RNFLDs were not associated with LVH or an elevated central BP, central PP, or cfPWV. However, they were associated with an elevated CACS (odds ratio, 1.44; 95% confidence interval, 1.04–2.00; p=0.029).Conclusions: Non-glaucomatous localized RNFLDs were associated with elevated CACS. Therefore, evaluating RNFLDs using fundus imaging may aid in the assessment of cardiovascular disease risk.

Elevated Coronary Artery Calcium scores are associated with tooth loss.

This study explores the association between Coronary Artery Calcium (CAC) scores and dental pathology such as missing teeth, the (peri-apical) health status and restoration grade of the teeth, and the grade of alveolar bone loss seen on a dental panoramic radiograph (Orthopantomograph-OPG). In this retrospective cross-sectional study, data was collected from three hospitals spread in the Netherlands. Patients were included when a CAC score and an OPG were available, both recorded within a maximum period of 365 days from 2009-2017. The CAC score was measured on a CT scan, using the Agatston method. To assess dental pathology, the number of missing teeth, the number of dental implants, alveolar bone loss, caries, endodontic treatments, peri-apical radiolucencies, bone loss at implants, impacted teeth and dental cysts, were determined on the OPG. All observers were calibrated. The electronic health records provided information about: gender, age, smoking, Diabetes Mellitus, hypercholesterolemia, hypertension and Body Mass Index (BMI). 212 patients were included. We found a statistically significant association between the number of missing teeth and the CAC score. When modeling age, sex, and other well-known risk factors for cardiovascular disease, the significant correlation was no longer present after multivariate correction. Furthermore, the results showed a trend for more teeth with peri-apical lesions and a higher percentage of mean alveolar bone loss in the group with the highest CAC scores. This study showed that being edentulous or missing teeth is correlated to higher CAC scores however failed to be an independent predictor of atherosclerotic cardiovascular diseases. The number of (missing) teeth is an easily accessible marker and could be used as a marker for atherosclerotic cardiovascular disease (ACVD) risk by almost any healthcare worker. The current study needs to be considered as an explorative pilot study and could contribute to the design of further (prospective) studies on the relationship between dental pathology and coronary artery calcification by adding clinical information and extra cardiovascular biomarkers.

Abstract 15317: Risk of Future Adverse Events in Patients Receiving Class IC Antiarrhythmic Drugs Who Have Elevated Coronary Artery Calcium Scores But Low-risk Cardiac Stress Test

Background: Class IC antiarrhythmic drugs (AAD) are a standard treatment of cardiac arrhythmias but are associated with harm in patients with prior myocardial infarction (MI)). Consensus guidelines have advocated that these drugs not be used in patients with coronary artery disease (CAD). However, the risk of Class IC AAD in patients with stable CAD, as demonstrated by an elevated coronary artery calcium (CAC) , but a low-risk cardiac stress test (LRCST), remains unclear. We hypothesized that the risk of future adverse cardiovascular events would not differ according to CAC severity among patients with an LRCST on Class Ic AAD treatment. Methods: We identified 355 patients without CAD and an LRCST (&lt;5% ischemia) on cardiac stress PET before initiation of Class IC AAD. CAC was assessed using quantitative scores when available or qualitative CAC assessment on low-dose attenuation correction CT. Patients were divided into no/low CAC (i.e., quantitative score &lt;100 or qualitative assessment of none/mild) or mod/severe CAC (i.e., quantitative score ≥100 or qualitative assessment of moderate/severe) The composite primary endpoint for this analysis was ventricular tachycardia/fibrillation (VT/VF), cardiac arrest, and all-cause death at one-year follow-up. Results: The majority of patients had no/low CAC (n = 278 [78.3%]) compared to mod/severe CAC (n = 77 [21.7%]). Those with no/low CAC were younger (62 vs 70, p&lt;0.0001) and were more likely to have a higher BMI (33.1 v 30.4, p=0.007) when compared to the mod/severe CAC group. Other cardiovascular risk factors were similar between groups. There was no difference in the one-year primary composite outcome of VT/VF, cardiac arrest, and death between no/low CAC compared to mod/severe CAC (3.6% vs 5.2%, p=0.51). Conclusion: In patients receiving Class IC AAD therapy with an LRCST, an elevated CAC did not increase the risk of future adverse events. These data suggest that using Class IC AAD may be safe in patients with stable CAD (no ischemia/elevated CAC). Future prospective trials are needed to evaluate the safety of Class IC AAD in patients with elevated CAC.

Abstract 16584: Inflammatory Bowel Disease is Independently Associated With Elevated Coronary Artery Calcium Score in Young Patients: Insights From CLARIFY Study

Introduction: Chronic inflammatory disease states are associated with higher incidence of premature atherosclerotic cardiovascular disease (ASCVD) in the young. However, data on whether younger patients with inflammatory bowel disease (IBD) are particularly at higher risk for subclinical atherosclerotic disease is scarce. Methods: Using data obtained from the CLARIFY registry (Clinicaltrials.gov NCT04075162), a prospective study of no-charge coronary artery calcium (CAC) testing at University Hospitals, we identified all patients with ulcerative colitis or Crohn’s disease and compared the presence (&gt;0) and high (≥100) CAC with all patients in CLARIFY without IBD stratified by age group (non-elderly: ≤65 years; elderly &gt;65 years), and adjusting for traditional ASCVD risk factors. Results: A total of 475 patients with IBD (252 UC, 196 CD, 27 both) and 43,437 controls without IBD were included. Compared with control, patients with IBD were more likely to be female (59% vs 50%, P&lt;0.001), to have diabetes (12% vs 17%, P&lt;0.001), and to be smokers (38% vs 22%, P&lt;0.001). Overall, 31% of adults with IBD had CAC&gt;100 compared to 28% without IBD (p=0.10). The respective prevalence was 25% vs. 21% (p=0.08) among non-elderly participants, and 45% vs. 47% (p=0.49) among elderly. In the total population, no association between IBD and CAC&gt;0 or CAC&gt;100 was noted. However, there was evidence of effect modification by pre-specified age strata (p-value for interaction 0.012, figure), where the odds of CAC≥100 was 1.38-fold higher (95% CI: 1.02-1.89) for IBD among participants ≤65 years vs among elderly participants [OR 0.84, 95% CI: 0.57-1.22]. Conclusions: Non-elderly IBD patients are at increased risk for significant coronary calcified atherosclerotic disease. Further studies are needed to understand underlying biological processes and implications of increased atherosclerotic disease risk among young adults with IBD.

Abstract 16464: Coronary Artery Calcium Score and Incidence of Clinically Significant Carotid Stenosis

Introduction: Coronary artery calcium (CAC) has been found to be associated with coronary artery plaque burden and is a major predictor of coronary heart disease (CHD) events. The data on its role in predicting carotid artery stenosis (CAS) is limited. Methods: Participants age ≥ 18 years with heart screen done from Nov 2008- Feb 2019 were selected and were assessed for documented diagnosis of carotid artery stenosis after their heart screen. Only the most recent heart screen per person and earliest documented CAS was considered. The chi-squared test and Welch’s 2-sample t-test was used to test for significant association between CAS and the nominal variables and mean calcium score respectively. Results: A total of 35,084 patient were screened for CAC score and 1439 (4.1%), were recorded to have a diagnosis of carotid artery stenosis. 53.5% being females and mean age of 63.69±9.31 years. The mean time between heart screen and documented diagnosis of CAS was 1529.4 ± 1211.0 days. The presence of CAS was significantly higher in patients ≥ 60 years (8.5%) as compared to those age &lt;60 years (2%). There was a significant difference in mean CAC score between those with CAS as compared to non- carotid stenosis group (324.2, vs 107.27, p&lt;.0001). In patient with elevated CAC ≥ 100, 9.98% had diagnosis of CAS, as compared to 2.82% in patients with CAC &lt;100, however among patients with diagnosis of CAS 46.6% had elevated CAC ≥ 100. Conclusions: The presence of carotid artery stenosis (CAS) was significantly associated with elevated coronary artery calcium score (≥100) and was significantly higher in patients with age ≥ 60 years, which in correct clinical context is helpful in suspecting CAS.

Can post-mortem coronary artery calcium scores aid diagnosis in young sudden death?

This study sought to explore the feasibility and utility of post-mortem coronary artery calcium (CAC) scoring in identifying patients with ischemic heart disease as cause of sudden death. 100 deceased patients aged 18-50years underwent post-mortem examination in the setting of sudden death. At post-mortem, fifty cases were determined to have ischemic heart disease, and fifty had death attributed to trauma or unascertained causes. The CAC score was calculated in a blinded manner from post-mortem CTs performed on all cases. CAC scores were assessable in 97 non-decomposed cases (feasibility 97%). The median CAC score was 88 Agatston units [IQR 0-286] in patients deceased from ischemic heart disease vs 0 [IQR 0-0] in patients deceased from other causes (p < 0.0001). Presence of any coronary calcification differed significantly between ischemic heart disease and non-ischemic groups (adjusted odds ratio 10.7, 95% CI 3.2-35.5). All cases with a CAC score > 100 (n = 22) had ischemic heart disease as the cause of death. Fifteen cases had a CAC score of zero but severe coronary disease at post-mortem examination. Post-mortem CAC scoring is highly feasible. An elevated CAC score in cases 18-50years old with sudden death predicts ischemic heart disease at post-mortem examination. However, a CAC score of zero does not exclude significant coronary artery disease. Post-mortem CAC score may be considered as a further assessment tool to help predict likely cause of death when there is an objection to or unavailability of post-mortem examination.

Associations Among Self-reported Physical Activity, Coronary Artery Calcium Scores, and Mortality Risk in Older Adults.

ObjectiveTo assess whether self-reported physical activity during daily life reduces the mortality risk associated with atherosclerotic burden, as measured by coronary artery calcium (CAC) scanning.MethodsWe assessed 2318 patients aged 65 to 84 years who underwent CAC scanning from August 31, 1998, through November 16, 2016, and had daily life physical activity assessed by a single-item question that was used to divide patients by low, moderate, and high physical activity levels. Patients were followed for a mean ± SD of 10.6±4.9 years for the occurrence of all-cause mortality.ResultsThe results indicated a graded relationship between the magnitude of CAC abnormality and mortality and an inverse relationship between physical activity and mortality. Of patients with low CAC scores (0-99), those with low, moderate, and high physical activity levels had similarly low mortality rates. Of patients with high CAC scores (≥400), however, there was a stepwise increase in mortality with decreasing physical activity. Patients with CAC scores of 400 or greater but reporting high physical activity had a mortality rate that was similar vs that observed in patients with CAC scores of only 0 to 99 and low physical activity (19.9 vs 16.3 per 1000 person-years; P=.60).ConclusionCombining CAC score with self-reported physical activity level provides a synergistic means for predicting clinical risk in older patients, with high physical activity level substantially attenuating the mortality risk associated with elevated CAC scores. Moreover, the useful prognostic information afforded by just a single-item physical activity questionnaire supports current initiatives to make such assessments into a “fifth vital sign.”

Age-Related Differences in the Noninvasive Evaluation for Possible Coronary Artery Disease

Although cardiovascular (CV) disease represents the leading cause of morbidity and mortality that increases with age, the best noninvasive test to identify older patients at risk for CV events remains unknown. To determine whether the prognostic utility of anatomic vs functional testing varies based on patient age. Prespecified analysis of the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) study, which used a pragmatic comparative effectiveness design. Participants were enrolled from 193 sites across North America and comprised outpatients without known coronary artery disease (CAD) but with symptoms suggestive of CAD. Data were analyzed between October 2018 and April 2019. Randomization to noninvasive testing with coronary computed tomographic angiography or functional testing. The composite of CV death/myocardial infarction (MI) over a median follow-up of 25 months. Among 10 003 PROMISE patients, we included the 8966 who received the noninvasive test to which they were randomized and had interpretable results; 6378 (71.1%) were younger than 65 years, 2062 (23.0%) were between ages 65 and 74 years, and 526 (5.9%) were 75 years and older. More than half of participants were women (4720 of 8966 [52.6%]). Only a minority of patients were of nonwhite race/ethnicity, a proportion that was lower among the older age groups (1071 of 6378 [16.8%] for <65 years; 258 of 2062 [12.5%] for age 65-74 years; 41 of 526 [7.8%] for ≥75 years). Compared with patients younger than 65 years, older patients were more likely to have a positive test result (age 65-74 years: odds ratio, 1.65; 95% CI, 1.42-1.91; age ≥75 years: odds ratio, 2.32; 95% CI, 1.83-2.95), regardless of noninvasive test completed. A positive functional test result was not associated with CV death/MI in patients younger than 65 years (hazard ratio [HR], 1.09; 95% CI, 0.43-2.82) but it was among older patients (age 65-74 years: HR, 3.18; 95% CI, 1.44-7.01; age ≥75 years: HR, 6.55; 95% CI, 1.46-29.35). Conversely, a positive anatomic test result was associated with CV death/MI among patients younger than 65 years (HR, 3.04; 95% CI, 1.46-6.34) but not among older patients (age, 65-74 years: HR, 0.67; 95% CI, 0.15-2.94; age ≥75 years: HR, 1.07; 95% CI, 0.22-5.34; P for interaction = .01). An elevated coronary artery calcium score was predictive of events in patients younger than 65 years (HR, 2.73; 95% CI, 1.31-5.69) but not for older patients (age 65-74 years: HR, 0.44; 95% CI, 0.14-1.42; age ≥75 years: HR, 1.31; 95% CI, 0.25-6.88). Older patients with stable symptoms suggestive of CAD are more likely to have a positive noninvasive test result and more coronary artery calcium. However, only a positive functional test result was associated with risk of CV death/MI. Age-specific approaches to noninvasive evaluation of CAD should be further examined. ClinicalTrials.gov identifier: NCT01174550.

Association of Coronary Artery Calcium With Long-term, Cause-Specific Mortality Among Young Adults

The level of coronary artery calcium (CAC) can effectively stratify cardiovascular risk in middle-aged and older adults, but its utility for young adults is unclear. To determine the prevalence of CAC in adults aged 30 to 49 years and the subsequent association of CAC with coronary heart disease (CHD), cardiovascular disease (CVD), and all-cause mortality. A multicenter retrospective cohort study was conducted among 22 346 individuals from the CAC Consortium who underwent CAC testing (baseline examination, 1991-2010, with follow-up through June 30, 2014; CAC quantified using nonconrast, cardiac-gated computed tomography scans) for clinical indications and were followed up for cause-specific mortality. Participants were free of clinical CVD at baseline. Statistical analysis was performed from June 1, 2017, to May 31, 2018. The prevalence of CAC and the subsequent rates of CHD, CVD, and all-cause mortality. Competing risks regression modeling was used to calculate multivariable-adjusted subdistribution hazard ratios for CHD and CVD mortality. The sample of 22 346 participants (25.0% women and 75.0% men; mean [SD] age, 43.5 [4.5] years) had a high prevalence of hyperlipidemia (49.6%) and family history of CHD (49.3%) but a low prevalence of current smoking (11.0%) and diabetes (3.9%). The prevalence of any CAC was 34.4%, with 7.2% having a CAC score of more than 100. During follow-up (mean [SD], 12.7 [4.0] years), there were 40 deaths related to CHD, 84 deaths related to CVD, and 298 total deaths. A total of 27 deaths related to CHD (67.5%) occurred among individuals with CAC at baseline. The CHD mortality rate per 1000 person-years was 10-fold higher among those with a CAC score of more than 100 (0.69; 95% CI, 0.41-1.16) compared with those with a CAC score of 0 (0.07; 95% CI, 0.04-0.12). After multivariable adjustment, those with a CAC score of more than 100 had a significantly increased risk of CHD (subdistribution hazard ratio, 5.6; 95% CI, 2.5-12.7), CVD (subdistribution hazard ratio, 3.3; 95% CI, 1.8-6.2), and all-cause mortality (hazard ratio, 2.6; 95% CI, 1.9-3.6) compared with those with a CAC score of 0. In a large sample of young adults undergoing CAC testing for clinical indications, 34.4% had CAC, and those with elevated CAC scores had significantly higher rates of CHD and CVD mortality. Coronary artery calcium may have potential utility for clinical decision-making among select young adults at elevated risk of cardiovascular disease.

Association of serum androgens and coronary artery calcium scores in women

To determine the association between serum androgens measured by high-resolution liquid chromatography-mass spectrometry and coronary artery calcium (CAC) scores. Cross-sectional study. Academic institution. A total of 239 women, aged 40-75years, with CAC testing and complete cardiovascular disease risk evaluation. Total T, DHEA, and androstenedione were measured using high-resolution liquid chromatography-mass spectrometry, whereas E2 and sex hormone-binding globulin were measured using commercial assays. None. Independent associations between CAC scores and sex steroids. Overall, 164 subjects had a CAC score < 10, 48 had a CAC score between 10 and 100, and 27 had a score > 100. There were no differences in sex hormone levels between women with CAC scores > 10 vs. CAC scores ≤ 10. In multivariable models adjusting for age, body mass index, and low-density lipoprotein cholesterol, a higher T/E2 ratio was associated with an elevated CAC score, with an unadjusted odds ratio associated with 1-SD change in log-transformed T/E2 of 1.38 (95% confidence interval 1.01-1.89) and adjusted OR 1.02 (95% confidence interval 1.002-1.04). Total T, DHEA, androstenedione, sex hormone-binding globulin, and E2 levels were not associated with increased CAC. In the general population, there are mixed reports regarding the relationship between serum androgens and risk factors for cardiovascular disease, and limited information on the relationship between androgens and subclinical atherosclerosis. Our study shows that increased androgens relative to estrogens may have a weak but independent association with subclinical atherosclerosis, as measured by CAC scores.

Coronary Artery Calcium Score in a Post-Mortem Population: Feasibility and Clinical Utility

Background: Post-mortem computed tomography (PMCT) may be considered as an adjunct to post-mortem examination. Coronary artery calcium (CAC) scores in living patients are known to reclassify cardiac risk. Methods: CAC score was calculated in a blinded manner from PMCTs of one hundred consecutive cases (18–50 years old) experiencing sudden death (ischaemic heart disease = 50, trauma/unascertained = 50). All patients subsequently underwent a post-mortem, with full cardiac results and demographics collected. Results: Cases were classified according to CAC score (CAC score 0, n = 58; CAC score 1–100, n = 17; CAC score 101–400, n = 15; CAC score >400, n = 7). CAC scores were assessable for ninety-seven cases (feasibility 97%). CAC score increased with age (p = 0.0004). Elevated CAC score correlated with pathological post-mortem cardiac changes including cardiac mass (p < 0.0001), biventricular wall thickness (p < 0.0001 left ventricle, p = 0.001 right ventricle), presence of any coronary disease (p = 0.005) and severe coronary disease (p < 0.0001). CAC score >zero had positive predictive value of 89.7% for severe coronary stenosis, and specificity of 91.5%. Sensitivity of CAC score > zero for severe stenosis was only 70%. Of cases with CAC score of zero, 25.9% had severe coronary disease (p < 0.0001). Conclusion: PM CAC scoring is highly feasible. Elevated CAC score in 18–50 years old with sudden death has high positive predictive value and specificity for coronary cause of death. However, CAC score of zero does not exclude a cardiac cause. PM CAC score assessment may be considered as a further tool to determine cause of death when there is objection to post-mortem.

Impact of the Coronary Artery Calcium Score on Mid- to Long-Term Cardiovascular Mortality and Morbidity Measured With Coronary Computed Tomography Angiography

Although the coronary artery calcium score (CACS) is a prognostic measurement in asymptomatic individuals, it is measured in symptomatic patients using coronary computed tomography angiography (CCTA). We aimed to examine the predictive value of the CACS for mid- to long-term cardiovascular mortality and morbidity in patients who underwent CCTA. Methods and Results: We studied 736 patients with suspected coronary artery disease (CAD) who underwent CCTA. During a median follow-up period of 6.5 years, there were 39 primary outcomes (composite of cardiovascular disease death, non-fatal myocardial infarction, and non-fatal stroke). The estimated 10-year cumulative rates of the primary outcome were significantly increased across CACS classes (3.9%, 9.2%, 11.8%, and 18.2% in CACS of 0, 1-99, 100-399, and ≥400, respectively, P<0.001). These rates of cardiovascular disease death and stroke were also significantly increased across CACS classes. Multivariate Cox proportional hazard analysis showed that a CACS ≥100 was independently predictive for the primary outcome (hazard ratio [HR] 2.82, 95% confidence interval [CI] 1.40-6.00, P=0.003), as well as the presence of ≥50% stenosis on CCTA (HR 2.27, 95% CI 1.13-4.46, P=0.022). An elevated CACS with the use of CCTA is an independent predictor of mid- to long-term cardiovascular mortality and morbidity in patients suspected of having CAD.

Relation between coronary artery calcium score and serum tenascin-C level in patients without known coronary artery disease.

Presence of coronary artery disease (CAD) also in subjects without traditional risk factors leads to a search for new risk factors. Tenascin-C (TNC), an extracellular matrix glycoprotein is normally found in very low concentrations in tissues and serum of adults, whereas its expression is enhanced in case of pathological conditions accompanied by inflammation. This study aimed to investigate the relation between coronary artery calcium score (CACS)and serum TNC level. Ninety patients (age range, 18-75 years) presenting with chest pain but without known CAD were divided according to their CACSs as control (CACS = 0, n = 30), low CACS (CACS between 0 and 400, n = 30), and high CACS (CACS ≥ 400, n = 30) groups. The patients were questioned about risk factors and underwent laboratory analyses for biochemical parameters including TNC. The mean TNC level was significantly higher in the high CACS group as compared to both the low CACS group and the control group [4.7 (0.03-30.7), 28 (0.7-212) and 84 (2-456) ng/mL, respectively; P < 0.01]. A positive correlation was determined between serum TNC level and CACS (r = 0.641, P < 0.001). In the ROC curve analysis, when the cut-off value for TNC was accepted as 8.09 ng/mL, the sensitivity and specificity in detecting patients with CACS > 100 (moderate or significant calcification) were 72% and 82%, respectively. A significant relationship was found between CACS and serum TNC level. Thus, measurement of TNC level can be used in determining elevated CACS and thereby the risk for CAD.

Automatic Coronary Artery Calcium Scoring on Radiotherapy Planning CT Scans of Breast Cancer Patients: Reproducibility and Association with Traditional Cardiovascular Risk Factors.

ObjectivesCoronary artery calcium (CAC) is a strong and independent predictor of cardiovascular disease (CVD) risk. This study assesses reproducibility of automatic CAC scoring on radiotherapy planning computed tomography (CT) scans of breast cancer patients, and examines its association with traditional cardiovascular risk factors.MethodsThis study included 561 breast cancer patients undergoing radiotherapy between 2013 and 2015. CAC was automatically scored with an algorithm using supervised pattern recognition, expressed as Agatston scores and categorized into five categories (0, 1–10, 11–100, 101–400, >400). Reproducibility between automatic and manual expert scoring was assessed in 79 patients with automatically determined CAC above zero and 84 randomly selected patients without automatically determined CAC. Interscan reproducibility of automatic scoring was assessed in 294 patients having received two scans (82% on the same day). Association between CAC and CVD risk factors was assessed in 36 patients with CAC scores >100, 72 randomly selected patients with scores 1–100, and 72 randomly selected patients without CAC. Reliability was assessed with linearly weighted kappa and agreement with proportional agreement.Results134 out of 561 (24%) patients had a CAC score above zero. Reliability of CVD risk categorization between automatic and manual scoring was 0.80 (95% Confidence Interval (CI): 0.74–0.87), and slightly higher for scans with breath-hold. Agreement was 0.79 (95% CI: 0.72–0.85). Interscan reliability was 0.61 (95% CI: 0.50–0.72) with an agreement of 0.84 (95% CI: 0.80–0.89). Ten out of 36 (27.8%) patients with CAC scores above 100 did not have other cardiovascular risk factors.ConclusionsAutomatic CAC scoring on radiotherapy planning CT scans is a reliable method to assess CVD risk based on Agatston scores. One in four breast cancer patients planned for radiotherapy have elevated CAC score. One in three patients with high CAC scores don't have other CVD risk factors and wouldn't have been identified as high risk.