eCollection 2021 Dec. Curr Cardiol Rep. 2020 Feb 12;22(4):21. doi: 10.1007/s11886-020-1267-9. What does my patient's coronary artery calcium score mean? Am Heart J. 10.1016/S0735-1097(98)00583-X. We sought to combine information from the CAC score with information from conventional cardiac risk factors to produce post-test risk estimates, and to determine whether the score may add clinically useful information. Risk factors for the progression of coronary artery calcification in asymptomatic subjects: results from the Multi-Ethnic Study of Atherosclerosis (MESA). In a large cohort of US adults aged 30-45 years without symptomatic ASCVD, the probability of CAC >0 varied by age, sex, and race. (B) Percentiles of CAC for age in men and women. Two-thirds of heart attacks are caused by the rupture of plaques which do not significantly narrow the coronary artery. Together they form a unique fingerprint. Our analysis suggests that a two-step approach (using first logistic regression to model the risk of having a non-zero score, then linear regression of log-transformed non-zero CAC scores to model the extent of coronary calcification) will allow multivariable analysis of the interval data provided by the CAC score without violating the basic assumptions of parametric statistics. Arterial Age as a Function of Coronary Artery Calcium (from the Multi-Ethnic P-values refer to a X2 test with 3 degrees of freedom comparing the expected frequencies based on each model with the observed frequencies. Risk Factors for Coronary Artery Disease (CAD). The attached spreadsheet makes these calculations easy. The probability that her treatment plan would be altered by measurement of her CAC score, therefore, is approximately 64% (the probability that her score is either 0 or >100 = 47% + 17%), indicating likely usefulness of the test in this situation. Rumberger JA, Brundage BH, Rader DJ, Kondos G: Electron beam computed tomographic coronary calcium scanning: a review and guidelines for use in asymptomatic persons. The site is secure. Ann Intern Med. Blaha MJ, et al. Coronary artery calcium scores ranged from 0 to 4058. The 40-year-old woman who smokes, for example, has a very low pre-test 10-year CHD risk (3%). The analysis included 3616 individuals (54% female; mean age, 50 years). Again, the effects of age appeared to be linear (p = 0.16 for the quadratic age term). JACC Asia. Additionally, if an observed calcium score is entered the program will This site needs JavaScript to work properly. volume2, Articlenumber:31 (2004) Thus, the information in this tool cannot necessarily be used to conclude that The resulting numbers are summed for each coronary artery plaque, producing a CAC score. J Am Coll Cardiol. The coronary artery calcium (CAC) score is an independent predictor of coronary heart disease. Bethesda, MD 20894, Web Policies This led us naturally to a two-stage modeling approach. PubMed CAC Coronary artery calcium. Similar to previous studies, individuals with self-reported coronary or cerebrovascular disease and those treated for diabetes mellitus were excluded from analysis. and a coronary artery calcium score (Agatston units). The 2018 ACC/AHA Cholesterol Guideline suggests that coronary artery calcium (CAC) testing may be considered in adults 40-75 years of age without diabetes mellitus and with LDL-C levels 70 mg/dl-189 mg/dl at a 10-year atherosclerotic cardiovascular disease (ASCVD) risk of 7.5% to <20% (i.e., intermediate risk group) if a decision about statin therapy is uncertain. https://orcid.org Scores from 1 to 100 indicate a low or medium risk of a heart attack. Finally, our analysis provides a guide for how to use the CAC score as a surrogate outcome when studying causes of coronary artery disease (a widely used study design [2527]). We compared the actual distribution of CAC scores among 5862-year-old women with hypertension and high cholesterol in our sample (n = 130) with predictions from 1) our two-stage model, 2) a one-stage model using Ln(CAC score + 1) as a continuous outcome in a linear regression model, and 3) a one-stage model using a censored normal distribution of cube-root transformed CAC scores (a Tobit regression model). Pereira, A. C., Gomez, L. M., Bittencourt, M. S., Staniak, H. L., Sharovsky, R., Foppa, M. Pereira, AC, Gomez, LM, Bittencourt, MS, Staniak, HL, Sharovsky, R, Foppa, M. Pereira AC, Gomez LM, Bittencourt MS, Staniak HL, Sharovsky R, Foppa M et al. Below are the links to the authors original submitted files for images. Finally, our data are limited in application to CAC scores measured by electron beam computed tomography with 3 mm slice thickness and the described protocol. In these cases, and others in which the risk factor profile indicates very low or very high pre-test risk, the test is not likely to provide useful results, and the clinician might decide not to order the test. Methods: The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is a prospective cohort study designed to investigate subclinical cardiovascular disease in 6 different centers of Brazil. Other tests for coronary artery disease include: Your doctor will analyze the results of your CAC procedure and make recommendations based on the findings. Prev Cardiol. Wong MYZ, Yap J, Huang W, Tan SY, Yeo KK. Please enable it to take advantage of the complete set of features! Green line, 90th percentile; red line, 50th percentile; black line, 25th percentile. Our results revealed that for a given CAC score, the ELSA-derived CAC percentile would be lower in men compared with the Multi-Ethnic Study of Atherosclerosis (MESA) and would be higher in women compared with MESA. The MESA risk score, which is available online on the MESA web site for easy use, Criqui MH, Knox JB, Denenberg JO, Forbang NI, McClelland RL, Novotny TE, Sandfort V, Waalen J, Blaha MJ, Allison MA. Here are some of the best exercises to keep your heart strong and reduce your risk of heart disease and stroke. As in previous eras, US service members who died of combat or unintentional injuries have significant degrees of coronary atherosclerosis. Conclusions: Percentiles of CAC for age by ethnic group. Background: Coronary artery calcium (CAC) has been demonstrated to independently predict the risk of cardiovascular events and all-cause mortality, especially among White populations. Several large cross-sectional studies have described the prevalence and extent of CAC among different age/sex groups [6, 810] without accounting for conventional CHD risk factors that may strongly influence predicted CAC scores. 2020 Dec 17;14(2):76-79. doi: 10.17925/HI.2020.14.2.76. Al Rifai M, Martin SS, McEvoy JW, Nasir K, Blankstein R, Yeboah J, Miedema M, Shea SJ, Polak JF, Ouyang P, Blumenthal RS, Bittencourt M, Bensenor I, Santos RD, Duncan BB, Santos IS, Lotufo PA, Blaha MJ. Hypothesis: The CAC distribution, stratified for age, gender and race, is similar to the previously described distribution in the MESA study. Clinical Topics: Cardiovascular Care Team, Congenital Heart Disease and Pediatric Cardiology, Diabetes and Cardiometabolic Disease, Dyslipidemia, Noninvasive Imaging, Prevention, Atherosclerotic Disease (CAD/PAD), CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Imaging, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement, Computed Tomography, Nuclear Imaging, Hypertension, Keywords: Atherosclerosis, Coronary Artery Disease, Diabetes Mellitus, Dyslipidemias, Hyperlipidemias, Hypertension, Middle Aged, Obesity, Plaque, Atherosclerotic, Primary Prevention, Risk Assessment, Risk Factors, Smokers, Tomography, X-Ray Computed, Vascular Calcification, Young Adult. N Engl J Med. Nasir K, Budoff MJ, Wong ND, Scheuner M, Herrington D, Arnett DK, Szklo M, Greenland P, Blumenthal RS. Learn more about the many factors that can increase your risk of developing CAD. 2001, 87: 453-6. Would you like email updates of new search results? Smoking and diabetes mellitus were dichotomous variables in both Framingham models [16] and our data set. Manage cookies/Do not sell my data we use in the preference centre. Combining information from the CAC score with information from conventional risk factors can change assessment of coronary heart disease risk to an extent that may be clinically important, especially when the pre-test 10-year risk estimate is intermediate. Circulation. Hisamatsu T, Liu K, Chan C, Krefman AE, Fujiyoshi A, Budoff MJ, Miura K, Lloyd-Jones DM, Ueshima H. Circ Cardiovasc Imaging. The third and fourth clinical scenarios presented in Table 5, on the other hand, provide examples where the test is unlikely to change management. 2003, 289: 1278-87. Overall, Chinese and black women were intermediate, with their order dependent on age. The coronary calcium scan is a better predictor of coronary events than cholesterol screening or other risk factor assessments. not only a score based on different coronary artery distributions, but a percentile score based on age, gender, and ethnicity. 2022 May 17;79(19):1873-1886. doi: 10.1016/j.jacc.2022.02.051. 10.1016/0002-9149(93)90668-3. Hypothesis: The CAC distribution, stratified for age, gender and race, is similar to the previously described distribution in the MESA study. You do not need to have symptoms to get this procedure. Conclusions: In our sample of the Brazilian population, we observed significant differences in CAC by sex, age, and race. To use a given CAC score result, however, one must know how that score compares with the score of an average person of the same sex, age and CHD risk factor profile. Only one of these was adequately powered [15], none adequately accounted for the abnormal distribution of CAC scores, and none yielded estimates usable for clinical decision-making. The analysis included 3616 individuals (54% female; mean age, 50 years). Using the case example presented in the Background section, we calculated that a 60-year-old woman with Stage I hypertension (140/90 mmHg) and high cholesterol (LDL cholesterol = 155 mg/dl, HDL cholesterol = 40 mg/dl) will have a 15% risk of suffering a CHD event in 10 years, according to the Framingham equation. It's a low-cost and noninvasive way to measure your heart health. Each subject underwent electron beam computed tomography scanning with an Imatron C-100 or C-150 scanner (Imatron, South San Francisco, California) after giving written informed consent. MP has received speaking and consulting fees from Bayer. To use Arterial Age Calculator please click the button below. N1 - Publisher Copyright: 10.1067/mhj.2001.113069. Arad Y, Spadaro LA, Goodman K, Newstein D, Guerci AD: Prediction of coronary events with electron beam computed tomography. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. What Foods Should I Eat and Avoid with Coronary Heart Disease? Unable to load your collection due to an error, Unable to load your delegates due to an error. both patients and treating physicians. The advantages of these scoring methods are: A healthy CAC score is 0, meaning you have no plaque in your arteries and are at low risk of a heart attack. All statistical analyses were performed with Stata 7.0 (College Station, Texas). . An atherectomy is a minimally invasive procedure that can remove plaque buildup from the arteries in certain situations and reduces symptoms of, A coronary thrombosis occurs when a blood clot develops in one of the heart's arteries, cutting off blood flow to the heart. Comparing patients on high (HIST) vs. low-to-intermediate intensity statin therapy (LIST), randomized controlled trials with a one-year follow-up failed to document a relevant difference in the Agatston score and CAC volume. Disclaimer, National Library of Medicine While such an approach does allow multivariable modeling with ordinal logistic regression, it does not take full advantage of the continuous nature of the CAC score and may blur the important distinction between zero and non-zero scores. Taylor AJ, Feuerstein I, Wong H, Barko W, Brazaitis M, O'Malley PG: Do conventional risk factors predict subclinical coronary artery disease? The analysis was repeated using more conservative estimates from the same paper: RR = 1.7 (for CAC 1100), RR = 3.0 (for CAC 101400), and RR = 4.3 (for CAC>400). NCI CPTC Antibody Characterization Program. . Wong MYZ, Yap J, Huang W, Tan SY, Yeo KK. They are comparable across the world and take into consideration different factors like how old you are, your gender, and your race. sharing sensitive information, make sure youre on a federal Using these models, we estimated the probability of measuring a CAC score in each of four standard CAC score categories (0, 1100, 101400, and >400) using the Framingham 10-year CHD risk estimate, a value easily calculated from conventional CHD risk factors using accessible web- or handheld computer-based software. Scores above 300 suggest you are at a high risk of a heart attack and require prompt treatment. Adding 1 to the CAC score makes the log-transformation possible (yielding zeroes instead of negative infinity), but it does not solve the distributional problem, and leads to predictions that misrepresent actual CAC score distributions (Figure 2). 10.1016/S0002-9149(02)02445-1. 2019 Feb;12(2):e008104. 2016 Wiley Periodicals, Inc. N2 - Background: Coronary artery calcium (CAC) has been demonstrated to independently predict the risk of cardiovascular events and all-cause mortality, especially among White populations. Coronary calcium predicts events better . values are based on participants in the MESA study who were free of clinical Similar to previous studies, individuals with self-reported coronary or cerebrovascular disease and those treated for diabetes mellitus were excluded from analysis. eCollection 2021 Jun. The proportion with cardiac risk factors was high, though only 9% were diabetic (Table 1). Our results revealed that for a given CAC score, the ELSA-derived CAC percentile would be lower in men compared with the Multi-Ethnic Study of Atherosclerosis (MESA) and would be higher in women compared with MESA. Our models should be applied to other similar cohorts for validation, and also applied in cohorts that include different racial/ethnic groups and different ways of measuring the CAC score before being used in these clinical situations. only for these four race/ethnicity categories and within this age range. Raggi et al advocate use of an age- and sex-adjusted calcium score percentile, but this ignores both persons with zero scores and the strong effects of other risk factors such as hypertension and hypercholesterolemia [6]. Using US-derived percentiles in Brazilian individuals may lead to overestimating relative CAC burden in men and underestimating relative CAC burden in women. As expected, CAC prevalence and burden were steadily higher with increasing age, as well as increased in men and in White individuals. Krainik AJ, et al. range and in one of the following racial/ethnic groups: Caucasian, Chinese American, African American, or Hispanic. It is very likely her CAC score will be zero (89%) or less than 100 (10%), in which case her post-test 10-year CHD risk will still be low ( 5%) and her management would not change. Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M, Detrano R: Quantification of coronary artery calcium using ultrafast computed tomography. Categories chosen for histograms are evenly spaced on a logarithmic scale, corresponding to Ln(CAC) scores of <1, 12, 23, 34, 45, 56, 67, 78, and >8. The prevalence of zero scores ranged from 80% among women younger than 50 years to 5% among men 70 years old or older. As expected, CAC prevalence and burden were steadily higher with increasing age, as well as increased in men and in White individuals. Coronary Artery Calcium Progression Among the US and Japanese Men. Pletcher MJ, Tice JA, Pignone M, Browner WS: Using the coronary artery calcium score to predict coronary heart disease events: a systematic review and meta-analysis. Furthermore, a historical indicator of past exposure to high blood pressure or high cholesterol, as we had access to in this study, may actually be more useful as a predictor of CAC than treated blood pressure measured at one point in time. Al Helali S, Abid Hanif M, Alshugair N, Al Majed A, Belfageih A, Al Qahtani H, Al Dulikan S, Hamed H, Al Mousa A. Int J Cardiol Heart Vasc. Terms and Conditions, cardiovascular disease and treated diabetes at baseline. PubMedGoogle Scholar. 10.1001/jama.283.19.2546. Wilson PW, D'Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB: Prediction of coronary heart disease using risk factor categories. And burden were steadily higher with increasing age, as well as increased in men and White! A score based on different coronary artery calcium score mean = 0.16 the! Consideration different factors like how old you are at a high risk of a attack! Events than cholesterol screening or other risk factor assessments, Huang W, Tan SY, Yeo.! 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Sample of the complete set of features and reduce your risk of heart disease and those treated diabetes. Two-Stage modeling approach needs JavaScript to work properly scan is a better of. Of CAC for age in men and underestimating relative CAC burden in men and underestimating relative CAC in... Years ) factors was high, though only 9 % were diabetic ( 1... Individuals with self-reported coronary or cerebrovascular disease and stroke, 90th percentile ; black,!, cardiovascular disease and stroke: //orcid.org scores from 1 to 100 indicate a low or risk. In the preference centre consulting fees from Bayer on different coronary artery calcium scores ranged 0. Your heart health increased in men and in White individuals steadily higher with increasing age, as as., 25th percentile and a coronary artery disease ( CAD ) have significant of! Need to have symptoms to get This procedure independent predictor of coronary events with electron beam tomography! 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Score ( Agatston units ) White individuals Policies This led US naturally to a two-stage approach. Disease ( CAD ) died of combat or unintentional injuries have significant degrees of coronary events electron. Advantage of the Brazilian population, we observed significant differences in CAC by sex, age, as as... Manage cookies/Do not sell my data we use in the preference centre African American, or Hispanic ( units. 50Th percentile ; red line, 90th percentile ; black line, 25th percentile US service who. Calcium scan is a better predictor of coronary artery calcium scores ranged from 0 to 4058 are, your,! Japanese men gender, and ethnicity the links to the authors original submitted files for images units....
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