Skip to main content
SpringerLink
Log in

Assessment of Cardiovascular Calcium: Interpretation and Relevance of Calcium Scoring Relationship to Lipids and Other Cardiovascular Risk Factors

  • Chapter
Cardiac CT Imaging

  • 1009 Accesses

Conclusions

The validation of CAC scanning as a risk assessment tool may well represent one of the most significant advances in the history of preventive medicine. It offers the possibility of accurately identifying the vast majority of patients destined to suffer acute cardiac events, and in so doing, will allow for substantial reduction of cardiovascular mortality and morbidity by increasingly effective pharmacologic therapy of the underlying disease process.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Heart and Stoke Statistical Update. Dallas, TX: American Heart Association, 2001.

    Google Scholar 

  2. Blankenhorn DH, Stern D. Calcification of the coronary arteries. Am J Roentgenol 1959;81:772–777.

    CAS  Google Scholar 

  3. Frink RJ, Achor RWP, Brown AL, et al. Significance of calcification of the coronary arteries. Am J Cardiol 1970;26:241–247.

    Article  PubMed  CAS  Google Scholar 

  4. Wexler L, Brundage B, Crouse J, et al. Coronary artery calcification: pathophysiology, epidemiology, image methods and clinical implications. A scientific statement from the American Heart Association. Circulation 1996;94:1175–1192.

    PubMed  CAS  Google Scholar 

  5. Faber A. Die Arteriosklerose, from Pathologische Anatomie, from Pathogenese Und Actiologie. G. Fischer, 1912.

    Google Scholar 

  6. Bostrom K, Watson KE, Horn S, et al. Bone morphogenetic protein expression in human atherosclerotic lesions. J Clin Invest 1993;91:1800–1809.

    PubMed  CAS  Google Scholar 

  7. Ideda T, Shirasawa T, Esaki Y, et al. Osteopontin mRNA is expressed by smooth muscle-derived foam cells in human atherosclerotic lesions of the aorta. J Clin Invest 1993;92:2814–2820.

    Google Scholar 

  8. Hirota S, Imakita M, Kohri K, et al. Expression of osteopontin messenger RNA by macrophages in atherosclerotic plaques. A possible association with calcification. Am J Pathol 1993;143:1003–1008.

    PubMed  CAS  Google Scholar 

  9. Shanahan CM, Cary NR, Metcalfe JC, Weissberg PL. High expression of genes for calcification-regulating proteins in human atherosclerotic plaque. J Clin Invest 1994;93:2393–2402.

    Article  PubMed  CAS  Google Scholar 

  10. Rumberger JA, Simons DB, Fitzpatrick LA, et al. Coronary artery calcium areas by electron beam computed tomography and coronary atherosclerotic plaque area: A histopathologic correlative study. Circulation 1995;92:2157–2162.

    PubMed  CAS  Google Scholar 

  11. Baumgart D, Schmermund A, Goerge G, et al. Comparison of electron beam computed tomography with intracoronary ultrasound and coronary angiography for detection of coronary atherosclerosis. J Am Coll Cardiol 1997;30:57–64.

    Article  PubMed  CAS  Google Scholar 

  12. Schmermund A, Baumgart D, Gorge G, et al. Coronary artery calcium in acute coronary syndromes: a comparative study of electron beam CT, coronary angiography, and intracoronary ultrasound in survivors of acute myocardial infarction and unstable angina. Circulation 1997;96:1461–1469.

    PubMed  CAS  Google Scholar 

  13. Agatston AS, Janowitz WR, Hildner FJ, et al. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 1990;15:827–832.

    PubMed  CAS  Google Scholar 

  14. Callister TQ, Cooil B, Raya SP, et al. Coronary artery disease: improved reproducibility of calcium scoring with an electron-beam CT volumetric method. Radiology 1998;208:807–814.

    PubMed  CAS  Google Scholar 

  15. Becker CR, Kleffel T, Crispin A, et al. Coronary artery calcium measurement. Agreement of multirow detector and electron beam CT. AJR Am J Roentgenol 2001;176:1295–1298.

    PubMed  CAS  Google Scholar 

  16. Janowitz WR, Agatston AS, Kaplan G, Viamonte M. Differences in prevalence and extent of coronary artery calcium detected by ultra-fast computed tomography in asymptomatic men and women. Am J Cardiol 1993;72:247–254.

    Article  PubMed  CAS  Google Scholar 

  17. Hoff JA, Chomka EV, Krainik AJ, et al. Age and gender distributions of coronary artery calcium detected by electron beam tomography in 35,246 adults. Am J Cardiol 2001;87:1335–1339.

    Article  PubMed  CAS  Google Scholar 

  18. Budoff MJ, Yang TP, Shavelle RM. Ethnic differences in coronary atherosclerosis. J Am Coll Cardiol 2002;39:408–412.

    Article  PubMed  Google Scholar 

  19. Newman AB, Naydeck BL, Whittle J, et al. Racial differences in coronary artery calcification in adults. Arterioscler Thromb Vasc Biol 2002;22:424–430.

    Article  PubMed  CAS  Google Scholar 

  20. Khuran C, Rosenbaum CG, Howard BV, et al. Coronary artery calcification in black women and white women. Am Heart J 2003;145:724–729.

    Article  Google Scholar 

  21. Jain T, Peshock R, Darren K. McGuire DK, et al. African Americans and Caucasians have a similar prevalence of coronary calcium in the Dallas Heart Study. J Am Coll Cardiol 2004;44:1011–1017.

    Article  PubMed  CAS  Google Scholar 

  22. Nasir K, Michos ED, Rumberger JA, et al. Coronary artery calcification and family history of premature coronary heart disease: sibling history is more strongly associated than parental history. Circulation 2004;110:2150–2156.

    Article  PubMed  Google Scholar 

  23. O’Rourke RA, Brundage BH, Froelicher VF, et al.: American College of Cardiology/American Heart Association expert consensus document on electron beam computed tomography for the diagnosis and prognosis of coronary artery disease. Circulation 2000;102:126–140.

    PubMed  CAS  Google Scholar 

  24. Simons DB, Schwartz RS, Edwards WD, et al: Noninvasive definition of anatomic coronary disease by ultrafast computed tomographic scanning: a quantitative pathologic comparison study. J Am Coll Cardiol 1992;20:1118–1126.

    Article  PubMed  CAS  Google Scholar 

  25. Detrano R, Tang W, Kang X, et al. Accurate coronary calcium phosphate mass measurements from electron beam computed tomograms. Am J Card Imaging 1995;9:167–173.

    PubMed  CAS  Google Scholar 

  26. Mautner GC, Mautner SL, Froelich J, et al. Coronary artery calcification: assessment with electron beam CT and histomorphometric correlation. Radiology 1994;192:619–623.

    PubMed  CAS  Google Scholar 

  27. Budoff MJ, Georgiou D, Brody A, et al. Ultrafast computed tomography as a diagnostic modality in the detection of coronary artery disease-a multicenter study. Circulation 1996;93:898–904.

    PubMed  CAS  Google Scholar 

  28. Wexler L, Brundage B, Crouse J et al. Coronary artery calcification: pathophysiology, epidemiology, imaging methods, and clinical implications: a statement for health professionals from the American Heart Association. Circulation 1996;94:1175–1192.

    PubMed  CAS  Google Scholar 

  29. Guerci AD, Spadaro LA, Popma JJ, et al. Electron Beam tomography of the coronary arteries: relationship of coronary calcium score to arteriographic findings in asymptomatic and symptomatic adults. Am J Cardiol 1997;79:128–133.

    Article  PubMed  CAS  Google Scholar 

  30. Shavelle DM, Budoff MJ, LaMont DH, Shavelle RM, Kennedy JM, Brundage BH. Exercise testing and electron beam computed tomography in the evaluation of coronary artery disease. J Am Coll Cardiol 2000;36:32–38.

    Article  PubMed  CAS  Google Scholar 

  31. Bielak LF, Rumberger JA, Sheedy PF, Schwartz RS, Peyser PA. Probabilistic model for prediction of angiographically defined obstructive coronary artery disease using electron beam computed tomography calcium score strata. Circulation 2000;102:380–385.

    PubMed  CAS  Google Scholar 

  32. Rumberger JA, Sheedy PF, Breen FJ, et al: Electron beam CT coronary calcium score cutpoints and severity of associated angiography luminal stenosis. J Am Coll Cardiol 1997;29:1542–1548.

    Article  PubMed  CAS  Google Scholar 

  33. Haberl R, Becker A, Leber A, et al. Correlation of coronary calcification and angiographically documented stenoses in patients with suspected coronary artery disease: results of 1,764 patients. J Am Coll Cardiol 2001;37:451–457.

    Article  PubMed  CAS  Google Scholar 

  34. Budoff MJ, Raggi P, Berman D, et al. Continuous probabilistic prediction of angiographically significant coronary artery disease using electron beam tomography. Circulation 2002;105(15):1791–1796.

    Article  PubMed  Google Scholar 

  35. Mohlenkamp S, Lehmann N, Schmermund A, et al. Prognostic value of extensive coronary calcium quantities in symptomatic males — a 5-year follow-up study. Eur Heart J 24:2003;24, 845–854.

    Article  PubMed  CAS  Google Scholar 

  36. Raggi P, Callister TQ, Cooil B, et al. Identification of patients at increased risk of first unheralded acute myocardial infarction by electron beam computed tomography. Circulation 2000;101:850–855.

    PubMed  CAS  Google Scholar 

  37. Wong ND, Hsu JC, Detrano RC, Diamond G, Eisenberg H, Gardin JM. Coronary artery calcium evaluation by electron beam computed tomography and its relation to new cardiovascular events. Am J Cardiol 2000;86:495–498.

    Article  PubMed  CAS  Google Scholar 

  38. Arad Y, Spadaro LA, Goodman K, Newstein D, Guerci AD. Prediction of coronary events with electron beam computed tomography. J Am Coll Cardiol 2000;36:1253–1260.

    Article  PubMed  CAS  Google Scholar 

  39. Kondos GT, Hoff JA, Sevrukov A, et al. Electron-beam tomography coronary artery calcium and cardiac events: a 37-month follow-up of 5,635 initially asymptomatic low to intermediate risk adults. Circulation 2003;107:2571–2576.

    Article  PubMed  Google Scholar 

  40. Shaw LJ, Raggi P, Schisterman E, et al. Prognostic value of cardiac risk factors and coronary artery calcium screening for all-cause mortality. Radiology 2003;28:826–833.

    Google Scholar 

  41. Greenland P, LaBree L, Azen SP, et al. Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. JAMA 2004;291:210–215.

    Article  PubMed  CAS  Google Scholar 

  42. Arad Y, Goodman KJ, Roth M, Newstein D, Guerci AD. Coronary calcification, coronary risk factors, and atherosclerotic cardiovascular disease events. The St Francis Heart Study. J Am Coll Cardiol 2005;46(1):158–165.

    Article  PubMed  CAS  Google Scholar 

  43. Wayhs R, Zelinger A, Raggi P. High coronary artery calcium scores pose an extremely elevated risk for hard events. J Am Coll Cardiol 2002;39:225–230.

    Article  PubMed  Google Scholar 

  44. Smith SC, Greenland P, Grundy SM. Prevention Conference V: beyond secondary prevention: identifying the high-risk patient for primary prevention. Executive summary. Circulation 2000;101:111–116.

    PubMed  Google Scholar 

  45. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Final Report. NIH Publication No. 02-5215. September 2002.

    Google Scholar 

  46. De Backer G, Ambrosioni E, Borch-Johnson K, et al. European guidelines on cardiovascular disease prevention in clinical practice. Third joint task force of European and other societies in cardiovascular disease prevention in clinical practice. Eur J Cardiovasc Prev Rehab 2003;10(Suppl 1):S1–S10.

    Article  Google Scholar 

  47. Mosca L, Appel LJ, Benjamin EJ, et al. Evidence-based guidelines for cardiovascular disease prevention in women. Expert Panel/Writing Group. Circulation 2004;109:672–693.

    Article  PubMed  Google Scholar 

  48. Tuzcu EM, Kapadia SR, Tutar E, et al. High prevalence of coronary atherosclerosis in asymptomatic teenagers and young adults: evidence from intravascular ultrasound. Circulation 2001;103:2705–2710.

    PubMed  CAS  Google Scholar 

  49. Budoff MJ, Ehrlich J, Hecht HS, Rumberger JR. Letter to the Editor. JAMA 2004;291:1822.

    Article  Google Scholar 

  50. Mascola A, Ko J, Bakhsheshi H, et al. Electron beam tomography comparison of culprit and non-culprit coronary arteries in patients with acute myocardial infarction. Am J Cardiol 2000;85:1357–1359.

    Article  PubMed  CAS  Google Scholar 

  51. Pohle K, Ropers D, Mäffert R, et al. Coronary calcifications in young patients with first, unheralded myocardial infarction: a risk factor matched analysis by electron beam tomography. Heart 2003;89:625–628.

    Article  PubMed  CAS  Google Scholar 

  52. Kuller LH, Matthews KA, Sutton-Tyrrell K, et al. Coronary and aortic calcification among women 8 years after menopause and their premenopausal risk factors: The Healthy Women Study. Arterioscler Thromb Vasc Biol 1999;19:2189–2198.

    PubMed  CAS  Google Scholar 

  53. Hecht HS, Superko HR, Smith LK, et al. Relation of coronary artery calcium identified by electron beam tomography to serum lipoprotein levels and implications for treatment. Am J Cardiol 2001;87:406–412.

    Article  PubMed  CAS  Google Scholar 

  54. Daviglus ML, Pirzada A, Liu K, et al. Comparison of low risk and higher risk profiles in middle age to frequency and quantity of coronary artery calcium years later. Am J Cardiol 2004;94:367–369.

    Article  PubMed  CAS  Google Scholar 

  55. Hecht HS, Superko HR. Electron beam tomography and national cholesterol education program guidelines in asymptomatic women. J Am Coll Cardiol 2001;37:1506–1511.

    Article  PubMed  CAS  Google Scholar 

  56. Taylor AJ, Feuerstein I, Wong H, et al. Do conventional risk factors predict subclinical coronary artery disease? Results from the Prospective Army Coronary Calcium Project. Am Heart J 2001;141:463–468.

    Article  PubMed  CAS  Google Scholar 

  57. Ridker PM, Wilson PW, Grundy SM. Should C-reactive protein be added to metabolic syndrome and to assessment of global cardiovascular risk? Circulation 2004;109:2818–2825.

    Article  PubMed  CAS  Google Scholar 

  58. Park R, Robert Detrano R, Xiang M, et al. Combined use of computed tomography coronary calcium scores and C-reactive protein levels in predicting cardiovascular events in nondiabetic individuals. Circulation 2002;106:2073–2077.

    Article  PubMed  CAS  Google Scholar 

  59. Arad Y, Spadaro LA, Roth M, Newstein D, Guerci AD. Treatment of asymptomatic adults with elevated coronary calcium scores with atorvastatin, vitamin C, and vitamin E: The St Francis Heart Study randomized clinical trial. J Am Coll Cardiol 2005;46(1):166–172.

    Article  PubMed  CAS  Google Scholar 

  60. Reilly MP, Wolfe ML, Localio AR, Rader DJ. C-reactive protein and coronary artery calcification: The Study of Inherited Risk of Coronary Atherosclerosis (SIRCA). Arterioscler Thromb Vasc Biol 2003;23:1851–1856.

    Article  PubMed  CAS  Google Scholar 

  61. O’Donnell CJ, Chazaro I, Wilson PWF, et al. Evidence for heritability of abdominal aortic calcific deposits in the Framingham Heart Study. Circulation 2002;106:337–341.

    Article  PubMed  Google Scholar 

  62. Peyser PA, Bielak LF, Chu J, et al. Heritability of coronary artery calcium quantity measured by electron beam computed tomography in asymptomatic adults. Circulation 2002;106:304–308.

    Article  PubMed  Google Scholar 

  63. Superko HR, Hecht HS. Metabolic disorders contribute to subclinical coronary atherosclerosis in patients with coronary calcification. Am J Cardiol 2001;88:260–264.

    Article  PubMed  CAS  Google Scholar 

  64. Hecht HS. “Interventional lipidology”: Tomographic plaque imaging and aggressive treatment of metabolic disorders. Am J Cardiol 2002;90:268–270.

    Article  PubMed  Google Scholar 

  65. Hecht HS, Budoff M, Ehrlich J, Rumberger J. Coronary artery calcium scanning: clinical recommendations for cardiac risk assessment and treatment. J Am Coll Cardiol 2005: In press.

    Google Scholar 

  66. Wilson PWF, D’Agostino B, Levy D, et al. Prediction of coronary heart disease using risk factor categories. Circulation 1998;97:1837–1847.

    PubMed  CAS  Google Scholar 

  67. Grundy SM, Cleeman JI, Merz CNB, et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation 2004;110:227–239.

    Article  PubMed  Google Scholar 

  68. Akosah K, Schaper A, Cogbill C, Schoenfeld P. Preventing myocardial infarction in the young adult in the first place: How do the National Cholesterol Education Panel III guidelines perform? J Am Coll Cardiol 2003;41:1475–1479.

    Article  PubMed  Google Scholar 

  69. Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20 536 high-risk individuals: a randomised placebo-controlled trial. Lancet 2002;360:7–22.

    Article  Google Scholar 

  70. Raggi P, Cooil B, Callister TQ. Use of electron beam tomography data to develop models for prediction of hard coronary events. Am Heart J 2001;141:375–382.

    Article  PubMed  CAS  Google Scholar 

  71. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) (Adult Treatment Panel III). JAMA 2001;285:2486–2497.

    Article  Google Scholar 

  72. Raggi P, Shaw LJ, Berman DS, Callister TQ. Prognostic value of coronary artery calcium screening in subjects with and without diabetes. J Am Coll Cardiol 2004;43:1663–1669.

    Article  PubMed  CAS  Google Scholar 

  73. Kuller LH, Velentgas P, Barzilay J, et al. Diabetes mellitus, subclinical cardiovascular disease and risk of incident cardiovascular disease and all-cause mortality. Arterioscler Thromb Vasc Biol 2000;20:823–829.

    PubMed  CAS  Google Scholar 

  74. Hoff JA, Quinn L, Sevrukov A, et al. The prevalence of coronary artery calcium among diabetic individuals without known coronary artery disease. J Am Coll Cardiol 2003;41:1008–1012.

    Article  PubMed  CAS  Google Scholar 

  75. LaMont DH, Budoff MJ, Shavelle DM, et al. Coronary calcium screening identifies patients with false positive stress tests (abstract). Circulation 1997;96:306–I.

    Google Scholar 

  76. Schmermund A, Baumgart D, Sack S, et al. Assessment of coronary calcification by electron-beam computed tomography in symptomatic patients with normal, abnormal or equivocal exercise stress test. Eur Heart J 2000;21:1674–1682.

    Article  PubMed  CAS  Google Scholar 

  77. Budoff MJ, Shavelle DM, Lamont DH, et al. Usefulness of electron beam computed tomography scanning for distinguishing ischemic from non-ischemic cardiomyopathy. J Am Coll Cardiol 1998;32:1173–1178.

    Article  PubMed  CAS  Google Scholar 

  78. Laudon DA, Vukov LF, Breen JF, et al. Use of electron-beam computed tomography in the evaluation of chest pain patients in the emergency department. Ann Emerg Med 1999;33:15–21.

    Article  PubMed  CAS  Google Scholar 

  79. Georgiou D, Budoff MJ, Kaufer E, et al. Screening patients with chest pain in the emergency department using electron beam tomography: a follow-up study. J Am Coll Cardiol 2001;38:105–110.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Cardiac Computed Tomography, Lenox Hill Heart and Vascular Institute, New York, USA

    Harvey S. Hecht MD, FACC

Authors
  1. Harvey S. Hecht MD, FACC
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Los Angeles Biomedical Research, Institute at Harbor-UCLA Medical Center, Torrance, CA, USA

    Matthew J. Budoff MD, FACC, FAHA

  2. Division of Cardiovascular Medicine, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA

    Jerold S. Shinbane MD, FACC

  3. Department of Internal Medicine II, University of Erlangen, Erlangen, Germany

    Stephan Achenbach MD, FESC

  4. Department of Cardiology, Tulane University School of Medicine, New Orleans, LA, USA

    Paolo Raggi MD

  5. Cardiovascular Disease, The Ohio State University, Dublin, OH, USA

    John A. Rumberger PhD, MD

Rights and permissions

Reprints and permissions

Copyright information

© 2006 Springer-Verlag London Limited

About this chapter

Cite this chapter

Hecht, H.S. (2006). Assessment of Cardiovascular Calcium: Interpretation and Relevance of Calcium Scoring Relationship to Lipids and Other Cardiovascular Risk Factors. In: Budoff, M.J., Shinbane, J.S., Achenbach, S., Raggi, P., Rumberger, J.A. (eds) Cardiac CT Imaging. Springer, London . https://doi.org/10.1007/1-84628-146-6_6

Download citation

  • DOI: https://doi.org/10.1007/1-84628-146-6_6

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-84628-028-3

  • Online ISBN: 978-1-84628-146-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation