The role of coronary artery calcium estimation in the primary prevention strategy for cardiovascular diseases
DOI:
https://doi.org/10.14739/2310-1210.2023.5.285583Keywords:
atherosclerosis, coronary artery calcium, computer tomography, primary prevention, statins, aspirinAbstract
Calcification is one of the stages of complicated and uncomplicated atherosclerotic plaque development. Determination of calcium deposits in the composition of plaques by the method of multispiral computer tomography allows to assess the coronary atherosclerotic lesion severity. The advantages of the test include a relatively wide availability, low cost and dose of ionizing radiation, as well as no need to inject a contrast agent. Calculation of the coronary artery calcium (CAC) according to the Agatston method is the “gold standard” for quantitative assessment of the coronary atherosclerosis severity.
The review highlights modern ideas about the role of the test in primary prevention in people without diagnosed cardiovascular disease. Methodological principles of determining coronary calcium are explained. The principles of test result interpretation and presentation based on the international СAC-RADS scale are described. Data from population studies on the prevalence of coronary calcification in people without cardiovascular disease in different age categories are provided. The results of the prognostic value of CAC based on the analysis of large population studies are presented. The prognostic value of a negative test (CAC = 0) for coronary calcium is discussed. Data are presented on the recommended frequency of repeated examinations in patients with CAC = 0 depending on an individual cardiovascular risk. The data of randomized clinical trials on the expediency of determining coronary calcium in certain age categories are given. The place of the test in international clinical recommendations for the primary prevention of cardiovascular diseases is analyzed. Research findings on a personalized approach to prescribing statins and aspirin based on coronary calcium test results are discussed. Data are provided on improved adherence in patients with coronary calcium screening compared with the standard approach. The limitations and shortcomings of the test are analyzed separately, among which the impossibility of controlling the effectiveness of hypolipidemic therapy with statins in dynamics can be identified. An integrated approach to the role of the coronary calcium test based on the analysis of current international clinical recommendations is provided.
References
Xu, X., Hua, Y., Liu, B., Zhou, F., Wang, L., & Hou, W. (2021). Correlation Between Calcification Characteristics of Carotid Atherosclerotic Plaque and Plaque Vulnerability. Therapeutics and clinical risk management, 17, 679-690. https://doi.org/10.2147/TCRM.S303485
Shi, X., Gao, J., Lv, Q., Cai, H., Wang, F., Ye, R., & Liu, X. (2020). Calcification in Atherosclerotic Plaque Vulnerability: Friend or Foe?. Frontiers in physiology, 11, 56. https://doi.org/10.3389/fphys.2020.00056
Nakahara, T., Dweck, M. R., Narula, N., Pisapia, D., Narula, J., & Strauss, H. W. (2017). Coronary Artery Calcification: From Mechanism to Molecular Imaging. JACC. Cardiovascular imaging, 10(5), 582-593. https://doi.org/10.1016/j.jcmg.2017.03.005
Rumberger, J. A., Simons, D. B., Fitzpatrick, L. A., Sheedy, P. F., & Schwartz, R. S. (1995). Coronary artery calcium area by electron-beam computed tomography and coronary atherosclerotic plaque area. A histopathologic correlative study. Circulation, 92(8), 2157=2162. https://doi.org/10.1161/01.cir.92.8.2157
Agatston, A. S., Janowitz, W. R., Hildner, F. J., Zusmer, N. R., Viamonte, M., Jr, & Detrano, R. (1990). Quantification of coronary artery calcium using ultrafast computed tomography. Journal of the American College of cardiology, 15(4), 827-832. https://doi.org/10.1016/0735-1097(90)90282-t
Hecht, H. S., Blaha, M. J., Kazerooni, E. A., Cury, R. C., Budoff, M., Leipsic, J., & Shaw, L. (2018). CAC-DRS: Coronary Artery Calcium Data and Reporting System. An expert consensus document of the Society of Cardiovascular Computed Tomography (SCCT). Journal of cardiovascular computed tomography, 12(3), 185-191. https://doi.org/10.1016/j.jcct.2018.03.008
Criqui, M. H., Knox, J. B., Denenberg, J. O., Forbang, N. I., McClelland, R. L., Novotny, T. E., Sandfort, V., Waalen, J., Blaha, M. J., & Allison, M. A. (2017). Coronary Artery Calcium Volume and Density: Potential Interactions and Overall Predictive Value: The Multi-Ethnic Study of Atherosclerosis. JACC. Cardiovascular imaging, 10(8), 845-854. https://doi.org/10.1016/j.jcmg.2017.04.018
Tota-Maharaj, R., Blaha, M. J., Blankstein, R., Silverman, M. G., Eng, J., Shaw, L. J., Blumenthal, R. S., Budoff, M. J., & Nasir, K. (2014). Association of coronary artery calcium and coronary heart disease events in young and elderly participants in the multi-ethnic study of atherosclerosis: a secondary analysis of a prospective, population-based cohort. Mayo Clinic proceedings, 89(10), 1350-1359. https://doi.org/10.1016/j.mayocp.2014.05.017
Osei, A. D., Uddin, S. M. I., Dzaye, O., Achirica, M. C., Dardari, Z. A., Obisesan, O. H., Kianoush, S., Mirbolouk, M., Orimoloye, O. A., Shaw, L., Rumberger, J. A., Berman, D., Rozanski, A., Miedema, M. D., Budoff, M. J., Vasan, R. S., Nasir, K., & Blaha, M. J. (2020). Predictors of coronary artery calcium among 20-30-year-olds: The Coronary Artery Calcium Consortium. Atherosclerosis, 301, 65-68. https://doi.org/10.1016/j.atherosclerosis.2020.04.006
Miedema, M. D., Dardari, Z. A., Nasir, K., Blankstein, R., Knickelbine, T., Oberembt, S., Shaw, L., Rumberger, J., Michos, E. D., Rozanski, A., Berman, D. S., Budoff, M. J., & Blaha, M. J. (2019). Association of Coronary Artery Calcium With Long-term, Cause-Specific Mortality Among Young Adults. JAMA network open, 2(7), e197440. https://doi.org/10.1001/jamanetworkopen.2019.7440
Tota-Maharaj, R., Blaha, M. J., McEvoy, J. W., Blumenthal, R. S., Muse, E. D., Budoff, M. J., Shaw, L. J., Berman, D. S., Rana, J. S., Rumberger, J., Callister, T., Rivera, J., Agatston, A., & Nasir, K. (2012). Coronary artery calcium for the prediction of mortality in young adults <45 years old and elderly adults >75 years old. European heart journal, 33(23), 2955-2962. https://doi.org/10.1093/eurheartj/ehs230
Carr, J. J., Jacobs, D. R., Jr, Terry, J. G., Shay, C. M., Sidney, S., Liu, K., Schreiner, P. J., Lewis, C. E., Shikany, J. M., Reis, J. P., & Goff, D. C., Jr (2017). Association of Coronary Artery Calcium in Adults Aged 32 to 46 Years With Incident Coronary Heart Disease and Death. JAMA cardiology, 2(4), 391-399. https://doi.org/10.1001/jamacardio.2016.5493
Dzaye, O., Razavi, A. C., Dardari, Z. A., Shaw, L. J., Berman, D. S., Budoff, M. J., Miedema, M. D., Nasir, K., Rozanski, A., Rumberger, J. A., Orringer, C. E., Smith, S. C., Jr, Blankstein, R., Whelton, S. P., Mortensen, M. B., & Blaha, M. J. (2021). Modeling the Recommended Age for Initiating Coronary Artery Calcium Testing Among At-Risk Young Adults. Journal of the American College of Cardiology, 78(16), 1573-1583. https://doi.org/10.1016/j.jacc.2021.08.019
Lee, S. E., Chang, H. J., Sung, J. M., Park, H. B., Heo, R., Rizvi, A., Lin, F. Y., Kumar, A., Hadamitzky, M., Kim, Y. J., Conte, E., Andreini, D., Pontone, G., Budoff, M. J., Gottlieb, I., Lee, B. K., Chun, E. J., Cademartiri, F., Maffei, E., Marques, H., Min, J. K. (2018). Effects of Statins on Coronary Atherosclerotic Plaques: The PARADIGM Study. JACC. Cardiovascular imaging, 11(10), 1475-1484. https://doi.org/10.1016/j.jcmg.2018.04.015
Dzaye, O., Dardari, Z. A., Cainzos-Achirica, M., Blankstein, R., Agatston, A. S., Duebgen, M., Yeboah, J., Szklo, M., Budoff, M. J., Lima, J. A. C., Blumenthal, R. S., Nasir, K., & Blaha, M. J. (2021). Warranty Period of a Calcium Score of Zero: Comprehensive Analysis From MESA. JACC. Cardiovascular imaging, 14(5), 990-1002. https://doi.org/10.1016/j.jcmg.2020.06.048
Blaha, M. J., Cainzos-Achirica, M., Greenland, P., McEvoy, J. W., Blankstein, R., Budoff, M. J., Dardari, Z., Sibley, C. T., Burke, G. L., Kronmal, R. A., Szklo, M., Blumenthal, R. S., & Nasir, K. (2016). Role of Coronary Artery Calcium Score of Zero and Other Negative Risk Markers for Cardiovascular Disease: The Multi-Ethnic Study of Atherosclerosis (MESA). Circulation, 133(9), 849-858. https://doi.org/10.1161/CIRCULATIONAHA.115.018524
Visseren, F. L. J., Mach, F., Smulders, Y. M., Carballo, D., Koskinas, K. C., Bäck, M., Benetos, A., Biffi, A., Boavida, J. M., Capodanno, D., Cosyns, B., Crawford, C., Davos, C. H., Desormais, I., Di Angelantonio, E., Franco, O. H., Halvorsen, S., Hobbs, F. D. R., Hollander, M., Jankowska, E. A., ESC Scientific Document Group (2021). 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. European heart journal, 42(34), 3227-3337. https://doi.org/10.1093/eurheartj/ehab484
Arnett, D. K., Blumenthal, R. S., Albert, M. A., Buroker, A. B., Goldberger, Z. D., Hahn, E. J., Himmelfarb, C. D., Khera, A., Lloyd-Jones, D., McEvoy, J. W., Michos, E. D., Miedema, M. D., Muñoz, D., Smith, S. C., Jr, Virani, S. S., Williams, K. A., Sr, Yeboah, J., & Ziaeian, B. (2019). 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation, 140(11), e596-e646. https://doi.org/10.1161/CIR.0000000000000678
Cosentino, F., Grant, P. J., Aboyans, V., Bailey, C. J., Ceriello, A., Delgado, V., Federici, M., Filippatos, G., Grobbee, D. E., Hansen, T. B., Huikuri, H. V., Johansson, I., Jüni, P., Lettino, M., Marx, N., Mellbin, L. G., Östgren, C. J., Rocca, B., Roffi, M., Sattar, N., … ESC Scientific Document Group (2020). 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. European heart journal, 41(2), 255-323. https://doi.org/10.1093/eurheartj/ehz486
Lindholt, J. S., Søgaard, R., Rasmussen, L. M., Mejldal, A., Lambrechtsen, J., Steffensen, F. H., Frost, L., Egstrup, K., Urbonaviciene, G., Busk, M., & Diederichsen, A. C. P. (2022). Five-Year Outcomes of the Danish Cardiovascular Screening (DANCAVAS) Trial. The New England journal of medicine, 387(15), 1385-1394. https://doi.org/10.1056/NEJMoa2208681
Mitchell, J. D., Fergestrom, N., Gage, B. F., Paisley, R., Moon, P., Novak, E., Cheezum, M., Shaw, L. J., & Villines, T. C. (2018). Impact of Statins on Cardiovascular Outcomes Following Coronary Artery Calcium Scoring. Journal of the American College of Cardiology, 72(25), 3233-3242. https://doi.org/10.1016/j.jacc.2018.09.051
Cainzos-Achirica, M., Miedema, M. D., McEvoy, J. W., Al Rifai, M., Greenland, P., Dardari, Z., Budoff, M., Blumenthal, R. S., Yeboah, J., Duprez, D. A., Mortensen, M. B., Dzaye, O., Hong, J., Nasir, K., & Blaha, M. J. (2020). Coronary Artery Calcium for Personalized Allocation of Aspirin in Primary Prevention of Cardiovascular Disease in 2019: The MESA Study (Multi-Ethnic Study of Atherosclerosis). Circulation, 141(19), 1541-1553. https://doi.org/10.1161/CIRCULATIONAHA.119.045010
Budoff, M. J., Kinninger, A., Gransar, H., Achenbach, S., Al-Mallah, M., Bax, J. J., Berman, D. S., Cademartiri, F., Callister, T. Q., Chang, H. J., Chow, B. J. W., Cury, R. C., Feuchtner, G., Hadamitzky, M., Hausleiter, J., Kaufmann, P. A., Leipsic, J., Lin, F. Y., Kim, Y. J., Marques, H., … CONFIRM Investigators (2023). When Does a Calcium Score Equates to Secondary Prevention?: Insights From the Multinational CONFIRM Registry. JACC. Cardiovascular imaging, S1936-878X(23)00151-1. Advance online publication. https://doi.org/10.1016/j.jcmg.2023.03.008
Peng, A. W., Dardari, Z. A., Blumenthal, R. S., Dzaye, O., Obisesan, O. H., Iftekhar Uddin, S. M., Nasir, K., Blankstein, R., Budoff, M. J., Bødtker Mortensen, M., Joshi, P. H., Page, J., & Blaha, M. J. (2021). Very High Coronary Artery Calcium (≥1000) and Association With Cardiovascular Disease Events, Non-Cardiovascular Disease Outcomes, and Mortality: Results From MESA. Circulation, 143(16), 1571-1583. https://doi.org/10.1161/CIRCULATIONAHA.120.050545
Rozanski, A., Gransar, H., Shaw, L. J., Kim, J., Miranda-Peats, L., Wong, N. D., Rana, J. S., Orakzai, R., Hayes, S. W., Friedman, J. D., Thomson, L. E., Polk, D., Min, J., Budoff, M. J., & Berman, D. S. (2011). 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. Journal of the American College of Cardiology, 57(15), 1622-1632. https://doi.org/10.1016/j.jacc.2011.01.019
Mehta, A., Rigdon, J., Tattersall, M. C., German, C. A., Barringer, T. A., 3rd, Joshi, P. H., Sperling, L. S., Budoff, M. J., Bertoni, A., Michos, E. D., Blaha, M. J., Stein, J. H., & Shapiro, M. D. (2021). Association of Carotid Artery Plaque With Cardiovascular Events and Incident Coronary Artery Calcium in Individuals With Absent Coronary Calcification: The MESA. Circulation. Cardiovascular imaging, 14(4), e011701. https://doi.org/10.1161/CIRCIMAGING.120.011701
Orringer, C. E., Blaha, M. J., Blankstein, R., Budoff, M. J., Goldberg, R. B., Gill, E. A., Maki, K. C., Mehta, L., & Jacobson, T. A. (2021). The National Lipid Association scientific statement on coronary artery calcium scoring to guide preventive strategies for ASCVD risk reduction. Journal of clinical lipidology, 15(1), 33-60. https://doi.org/10.1016/j.jacl.2020.12.005
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