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Screening for Coronary Artery Calcium

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Comprehensive Cardiovascular Medicine in the Primary Care Setting

Part of the book series: Contemporary Cardiology ((CONCARD))

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Abstract

The striking improvement in cardiovascular therapies during the last several decades has caused a marked decrease in mortality linked to atherosclerotic diseases in Western societies. Nonetheless, coronary artery disease (CAD) remains the main cause of non-fatal events, and it is associated with substantial functional impairment in survivors of acute events, imposing a very large economic burden on societies. The use of risk scoring tools helps to identify patients both at higher risk of disease and those who are most likely to benefit from therapeutic intervention. Unfortunately, it has become apparent that most of these tools are not completely accurate, and many patients considered to be at low risk suffer coronary events, and, on the contrary, intermediate- to high-risk patients may actually be at a much lower risk than predicted. The attention of several investigators, therefore, turned to the development of imaging tools to identify atherosclerosis or its signature in its pre-clinical stages.

Key Points

• Most risk stratification tools are not completely accurate, and many patients considered to be at low risk suffer coronary events, while some intermediate- to high-risk patients may be at lower than predicted risk. The focus has, therefore, turned to imaging tools to identify atherosclerosis in its pre-clinical stages.

• Calcium deposition accompanies the formation of atherosclerotic plaque from its inception, and it proceeds via active processes of mineralization similar to bone formation. The extent of coronary artery calcium is a good marker of the presence of atherosclerosis, although it represents only 15–20% of the total atheroma volume.

• There is a large amount of data to show that coronary artery calcium is an independent predictor of cardiovascular events among patients at intermediate risk in the general population. It also adds incremental prognostic information beyond traditional risk factors in this segment of the population.

• There are no data to support calcium imaging in low-risk patients, while there are good initial data to support its use even in high-risk individuals such as diabetic patients and the elderly.

• Women benefit from calcium screening even more than men because the accuracy of risk prediction models based on traditional risk factors is lower in women.

• The ability of coronary artery calcium to predict risk has been shown to be equal for patients of different ethnicities (Caucasian, African-American, Asian, and Hispanic).

• Extent of coronary calcium can be used to adjust the age of the individual patient according to the extent of subclinical atherosclerosis detected. The concept of vascular age can be applied to predict the number of life years lost by the individual.

• Calcium screening in low-risk symptomatic patients helps discriminate patients in need of further testing from those that can be managed medically and discharged from the emergency department.

• Regression of coronary artery calcium has not yet been conclusively shown to be attainable. However, continued accumulation of large amounts of calcium has been clearly shown to be linked with unfavorable cardiovascular events.

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Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine, Emory University Hospital, Atlanta, GA, USA

    Nikolaos Alexopoulos MD, Dalton S. McLean MD & Stamatios Lerakis MD

  2. Division of Cardiology, Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA

    Paolo Raggi MD

  3. Department of Nephrology, Ospedale San Paolo, Milan, Italy

    Paolo Raggi MD

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  1. Nikolaos Alexopoulos MD
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  2. Dalton S. McLean MD
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  3. Stamatios Lerakis MD
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  4. Paolo Raggi MD
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  1. Sterling Rock Falls Clinic, 101 E. Miller Road, Sterling, 61081, USA

    Peter P. Toth

  2. Brigham & Women's Hospital, Cardiovascular Division, Harvard Medical School, Longwood Ave. 350, Boston, 02115, USA

    Christopher P. Cannon

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Alexopoulos, N., McLean, D.S., Lerakis, S., Raggi, P. (2011). Screening for Coronary Artery Calcium. In: Toth, P., Cannon, C. (eds) Comprehensive Cardiovascular Medicine in the Primary Care Setting. Contemporary Cardiology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60327-963-5_26

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