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Role of Coronary Artery Calcium in Cardiovascular Risk Stratification and Management in the Aging Population

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Aging and Heart Failure

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Abstract

Ischemic cardiomyopathy remains the most common form of heart failure among the elderly despite important advances in the prevention and management of coronary heart disease. Controlling cardiovascular risk factors for coronary heart disease is the most effective way to reduce the burden of ischemic cardiomyopathy in elderly populations. Appropriate application of proven preventive therapies relies heavily on the accurate estimation of cardiovascular risk. Currently favored risk prediction models place a disproportionate emphasis on chronologic age resulting in the misclassification of risk in many elderly individuals. Coronary artery calcium scoring is a simple test that can be used to estimate the burden of coronary atherosclerosis and help “personalize” the approach to treatment of cardiovascular risk independent of chronologic age. Coronary artery calcium scores accurately predict cardiovascular events in older patients and effectively reclassify risk in elderly individuals with subsequent alteration of treatment goals. The improvement in risk prediction that coronary calcium offers promotes the use of preventive therapies in individuals who will receive the most benefit, while at the same time avoiding polypharmacy in those who would receive the least benefit.

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References

  1. Lloyd-Jones DM, Larson MG, Beiser A, Levy D. Lifetime risk of developing coronary heart disease. Lancet. 1999;353:89–92.

    Article  CAS  PubMed  Google Scholar 

  2. Ezekowitz JA, Kaul P, Bakal JA, Armstrong PW, Welsh RC, McAlister FA. Declining in-hospital mortality and increasing heart failure incidence in elderly patients with first myocardial infarction. J Am Coll Cardiol. 2009;53:13–20.

    Article  PubMed  Google Scholar 

  3. He J, Ogden LG, Bazzano LA, Vupputuri S, Loria C, Whelton PK. Risk factors for congestive heart failure in us men and women: NHANES I epidemiologic follow-up study. Arch Intern Med. 2001;161:996–1002.

    Article  CAS  PubMed  Google Scholar 

  4. Raftery EB, Banks DC, Oram S. Occlusive disease of the coronary arteries presenting as primary congestive cardiomyopathy. Lancet. 1969;2:1146–50.

    CAS  PubMed  Google Scholar 

  5. Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte Jr M, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 1990;15:827–32.

    Article  CAS  PubMed  Google Scholar 

  6. Deedwania P, Stone PH, Bairey Merz CN, Cosin-Aguilar J, Koylan N, Luo D, Ouyang P, Piotrowicz R, Schenck-Gustafsson K, Sellier P, Stein JH, Thompson PL, Tzivoni D. Effects of intensive versus moderate lipid-lowering therapy on myocardial ischemia in older patients with coronary heart disease: results of the study assessing goals in the elderly (sage). Circulation. 2007;115:700–7.

    Article  CAS  PubMed  Google Scholar 

  7. Lewis SJ, Moye LA, Sacks FM, Johnstone DE, Timmis G, Mitchell J, Limacher M, Kell S, Glasser SP, Grant J, Davis BR, Pfeffer MA, Braunwald E. Effect of pravastatin on cardiovascular events in older patients with myocardial infarction and cholesterol levels in the average range. Results of the cholesterol and recurrent events (care) trial. Ann Intern Med. 1998;129:681–9.

    Article  CAS  PubMed  Google Scholar 

  8. Beckett N, Peters R, Tuomilehto J, Swift C, Sever P, Potter J, McCormack T, Forette F, Gil-Extremera B, Dumitrascu D, Staessen JA, Thijs L, Fletcher A, Bulpitt C. Immediate and late benefits of treating very elderly people with hypertension: results from active treatment extension to hypertension in the very elderly randomised controlled trial. BMJ. 2012;344:d7541.

    Article  CAS  Google Scholar 

  9. Mozaffarian D, Kamineni A, Carnethon M, Djousse L, Mukamal KJ, Siscovick D. Lifestyle risk factors and new-onset diabetes mellitus in older adults: the cardiovascular health study. Arch Intern Med. 2009;169:798–807.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Staessen JA, Gasowski J, Wang JG, Thijs L, Den Hond E, Boissel JP, Coope J, Ekbom T, Gueyffier F, Liu L, Kerlikowske K, Pocock S, Fagard RH. Risks of untreated and treated isolated systolic hypertension in the elderly: meta-analysis of outcome trials. Lancet. 2000;355:865–72.

    Article  CAS  PubMed  Google Scholar 

  11. Cournot M, Cambou JP, Quentzel S, Danchin N. Key factors associated with the under-prescription of statins in elderly coronary heart disease patients: results from the eliage and elicoeur surveys. Int J Cardiol. 2006;111:12–8.

    Article  PubMed  Google Scholar 

  12. Rozanski A, Gransar H, Shaw LJ, Kim J, Miranda-Peats L, Wong ND, Rana JS, Orakzai R, Hayes SW, Friedman JD, Thomson LE, Polk D, Min J, Budoff MJ, Berman DS. Impact of coronary artery calcium scanning on coronary risk factors and downstream testing the eisner (early identification of subclinical atherosclerosis by noninvasive imaging research) prospective randomized trial. J Am Coll Cardiol. 2011;57:1622–32.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  13. Genest J, McPherson R, Frohlich J, Anderson T, Campbell N, Carpentier A, Couture P, Dufour R, Fodor G, Francis GA, Grover S, Gupta M, Hegele RA, Lau DC, Leiter L, Lewis GF, Lonn E, Mancini GB, Ng D, Pearson GJ, Sniderman A, Stone JA, Ur E. 2009 Canadian cardiovascular society/Canadian guidelines for the diagnosis and treatment of dyslipidemia and prevention of cardiovascular disease in the adult – 2009 recommendations. Can J Cardiol. 2009;25:567–79.

    Article  CAS  PubMed  Google Scholar 

  14. 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. Circulation. 2002;106:3143–421.

    Google Scholar 

  15. US Preventive Services Task Force. Aspirin for the prevention of cardiovascular disease: US Preventive Services Task Force recommendation statement. Ann Intern Med. 2009;150:396–404.

    Article  Google Scholar 

  16. Kannel WB, D’Agostino RB, Silbershatz H. Blood pressure and cardiovascular morbidity and mortality rates in the elderly. Am Heart J. 1997;134:758–63.

    Article  CAS  PubMed  Google Scholar 

  17. Anderson KM, Castelli WP, Levy D. Cholesterol and mortality. 30 years of follow-up from the Framingham study. JAMA. 1987;257:2176–80.

    Article  CAS  PubMed  Google Scholar 

  18. Franklin SS, Larson MG, Khan SA, Wong ND, Leip EP, Kannel WB, Levy D. Does the relation of blood pressure to coronary heart disease risk change with aging? The Framingham heart study. Circulation. 2001;103:1245–9.

    Article  CAS  PubMed  Google Scholar 

  19. Shipley MJ, Pocock SJ, Marmot MG. Does plasma cholesterol concentration predict mortality from coronary heart disease in elderly people? 18 year follow up in Whitehall study. BMJ. 1991;303:89–92.

    Article  CAS  PubMed  Google Scholar 

  20. Assmann G, Cullen P, Schulte H. The munster heart study (PROCAM). Results of follow-up at 8 years. Eur Heart J. 1998;19(Suppl A):A2–11.

    PubMed  Google Scholar 

  21. Wilson PW, D'Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of coronary heart disease using risk factor categories. Circulation. 1998;97:1837–47.

    Article  CAS  PubMed  Google Scholar 

  22. Grundy SM. Age as a risk factor: you are as old as your arteries. Am J Cardiol. 1999;83:1455–7. A1457.

    Article  CAS  PubMed  Google Scholar 

  23. Grundy SM. Coronary plaque as a replacement for age as a risk factor in global risk assessment. Am J Cardiol. 2001;88:8E–11.

    Article  CAS  PubMed  Google Scholar 

  24. Detrano R, Guerci AD, Carr JJ, Bild DE, Burke G, Folsom AR, Liu K, Shea S, Szklo M, Bluemke DA, O'Leary DH, Tracy R, Watson K, Wong ND, Kronmal RA. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med. 2008;358:1336–45.

    Article  CAS  PubMed  Google Scholar 

  25. Erbel R, Mohlenkamp S, Moebus S, Schmermund A, Lehmann N, Stang A, Dragano N, Gronemeyer D, Seibel R, Kalsch H, Brocker-Preuss M, Mann K, Siegrist J, Jockel KH. Coronary risk stratification, discrimination, and reclassification improvement based on quantification of subclinical coronary atherosclerosis: the Heinz Nixdorf recall study. J Am Coll Cardiol. 2010;56:1397–406.

    Article  PubMed  Google Scholar 

  26. Elias-Smale SE, Proenca RV, Koller MT, Kavousi M, van Rooij FJ, Hunink MG, Steyerberg EW, Hofman A, Oudkerk M, Witteman JC. Coronary calcium score improves classification of coronary heart disease risk in the elderly: the Rotterdam study. J Am Coll Cardiol. 2010;56:1407–14.

    Article  PubMed  Google Scholar 

  27. Budoff MJ, Shaw LJ, Liu ST, Weinstein SR, Mosler TP, Tseng PH, Flores FR, Callister TQ, Raggi P, Berman DS. Long-term prognosis associated with coronary calcification: observations from a registry of 25,253 patients. J Am Coll Cardiol. 2007;49:1860–70.

    Article  PubMed  Google Scholar 

  28. Hoff JA, Chomka EV, Krainik AJ, Daviglus M, Rich S, Kondos GT. Age and gender distributions of coronary artery calcium detected by electron beam tomography in 35,246 adults. Am J Cardiol. 2001;87:1335–9.

    Article  CAS  PubMed  Google Scholar 

  29. McClelland RL, Chung H, Detrano R, Post W, Kronmal RA. Distribution of coronary artery calcium by race, gender, and age: results from the multi-ethnic study of atherosclerosis (MESA). Circulation. 2006;113:30–7.

    Article  PubMed  Google Scholar 

  30. Wong ND, Budoff MJ, Pio J, Detrano RC. Coronary calcium and cardiovascular event risk: evaluation by age- and sex-specific quartiles. Am Heart J. 2002;143:456–9.

    Article  PubMed  Google Scholar 

  31. McClelland RL, Nasir K, Budoff M, Blumenthal RS, Kronmal RA. Arterial age as a function of coronary artery calcium (from the multi-ethnic study of atherosclerosis [MESA]). Am J Cardiol. 2009;103:59–63.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  32. Vliegenthart R, Oudkerk M, Hofman A, Oei HH, van Dijck W, van Rooij FJ, Witteman JC. Coronary calcification improves cardiovascular risk prediction in the elderly. Circulation. 2005;112:572–7.

    Article  PubMed  Google Scholar 

  33. Raggi P, Gongora MC, Gopal A, Callister TQ, Budoff M, Shaw LJ. Coronary artery calcium to predict all-cause mortality in elderly men and women. J Am Coll Cardiol. 2008;52:17–23.

    Article  PubMed  Google Scholar 

  34. Abbott RD, Ueshima H, Masaki KH, Willcox BJ, Rodriguez BL, Ikeda A, Yano K, White LR, Curb JD. Coronary artery calcification and total mortality in elderly men. J Am Geriatr Soc. 2007;55:1948–54.

    Article  PubMed  Google Scholar 

  35. Tota-Maharaj R, Blaha MJ, McEvoy JW, Blumenthal RS, Muse ED, Budoff MJ, Shaw LJ, Berman DS, Rana JS, Rumberger J, Callister T, Rivera J, Agatston A, Nasir K. Coronary artery calcium for the prediction of mortality in young adults <45 years old and elderly adults >75 years old. Eur Heart J. 2012;33(23):2955–62.

    Article  CAS  PubMed  Google Scholar 

  36. Peters SA, den Ruijter HM, Bots ML, Moons KG. Improvements in risk stratification for the occurrence of cardiovascular disease by imaging subclinical atherosclerosis: a systematic review. Heart. 2012;98:177–84.

    Article  PubMed  Google Scholar 

  37. Yeboah J, McClelland RL, Polonsky TS, Burke GL, Sibley CT, O'Leary D, Carr JJ, Goff DC, Greenland P, Herrington DM. Comparison of novel risk markers for improvement in cardiovascular risk assessment in intermediate-risk individuals. JAMA. 2012;308:788–95.

    Article  CAS  PubMed  Google Scholar 

  38. Hunt SA, Baker DW, Chin MH, Cinquegrani MP, Feldman AM, Francis GS, Ganiats TG, Goldstein S, Gregoratos G, Jessup ML, Noble RJ, Packer M, Silver MA, Stevenson LW, Gibbons RJ, Antman EM, Alpert JS, Faxon DP, Fuster V, Jacobs AK, Hiratzka LF, Russell RO, Smith Jr SC. ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: executive summary. A report of the American college of cardiology/American heart association task force on practice guidelines (committee to revise the 1995 guidelines for the evaluation and management of heart failure). J Am Coll Cardiol. 2001;38:2101–13.

    Article  CAS  PubMed  Google Scholar 

  39. Mureddu GF, Agabiti N, Rizzello V, Forastiere F, Latini R, Cesaroni G, Masson S, Cacciatore G, Colivicchi F, Uguccioni M, Perucci CA, Boccanelli A. Prevalence of preclinical and clinical heart failure in the elderly. A population-based study in central Italy. Eur J Heart Fail. 2012;14:718–29.

    Article  PubMed  Google Scholar 

  40. Leening MJ, Elias-Smale SE, Kavousi M, Felix JF, Deckers JW, Vliegenthart R, Oudkerk M, Hofman A, Steyerberg EW, Stricker BH, Witteman JC. Coronary calcification and the risk of heart failure in the elderly: the Rotterdam study. JACC Cardiovasc Imaging. 2012;5:874–80.

    Article  PubMed  Google Scholar 

  41. Purser JL, Kuchibhatla MN, Fillenbaum GG, Harding T, Peterson ED, Alexander KP. Identifying frailty in hospitalized older adults with significant coronary artery disease. J Am Geriatr Soc. 2006;54:1674–81.

    Article  PubMed  Google Scholar 

  42. Alexander KP, Newby LK, Cannon CP, Armstrong PW, Gibler WB, Rich MW, Van de Werf F, White HD, Weaver WD, Naylor MD, Gore JM, Krumholz HM, Ohman EM. Acute coronary care in the elderly, Part I: Non-ST-segment-elevation acute coronary syndromes: a scientific statement for healthcare professionals from the American heart association council on clinical cardiology: in collaboration with the society of geriatric cardiology. Circulation. 2007;115:2549–69.

    Article  PubMed  Google Scholar 

  43. Newman AB, Gottdiener JS, McBurnie MA, Hirsch CH, Kop WJ, Tracy R, Walston JD, Fried LP. Associations of subclinical cardiovascular disease with frailty. J Gerontol A Biol Sci Med Sci. 2001;56:M158–66.

    Article  CAS  PubMed  Google Scholar 

  44. Tjam EY, Heckman GA, Smith S, Arai B, Hirdes J, Poss J, McKelvie RS. Predicting heart failure mortality in frail seniors: comparing the NYHA functional classification with the resident assessment instrument (RAI) 2.0. Int J Cardiol. 2012;155:75–80.

    Article  PubMed  Google Scholar 

  45. Afilalo J. Frailty in patients with cardiovascular disease: why, when, and how to measure. Curr Cardiovasc Risk Rep. 2011;5:467–72.

    Article  PubMed Central  PubMed  Google Scholar 

  46. Desai MY, Nasir K, Rumberger JA, Braunstein JB, Post WS, Budoff MJ, Blumenthal RS. Relation of degree of physical activity to coronary artery calcium score in asymptomatic individuals with multiple metabolic risk factors. Am J Cardiol. 2004;94:729–32.

    Article  CAS  PubMed  Google Scholar 

  47. Inzitari M, Naydeck BL, Newman AB. Coronary artery calcium and physical function in older adults: the cardiovascular health study. J Gerontol A Biol Sci Med Sci. 2008;63:1112–8.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Cardiology, Mazankowski Alberta Heart Institute, Department of Medicine, University of Alberta Hospital, 8440-112 Street, Edmonton, AB, Canada, T6G 2B7

    Craig R. Butler MSc, MD & Paolo Raggi MD

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  1. Craig R. Butler MSc, MD
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  2. Paolo Raggi MD
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Correspondence to Craig R. Butler MSc, MD .

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  1. Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, University of Alberta and Hospitals, Edmonton, Alberta, Canada

    Bodh I. Jugdutt

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Butler, C.R., Raggi, P. (2014). Role of Coronary Artery Calcium in Cardiovascular Risk Stratification and Management in the Aging Population. In: Jugdutt, B. (eds) Aging and Heart Failure. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-0268-2_17

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  • DOI: https://doi.org/10.1007/978-1-4939-0268-2_17

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