Comparison of coronary artery calcium detected by electron beam tomography in patients with to those without symptomatic coronary heart disease

doi:10.1016/S0002-9149(03)00714-8

The American Journal of Cardiology

Volume 92, Issue 5, 1 September 2003, Pages 498-503

https://doi.org/10.1016/S0002-9149(03)00714-8 Get rights and content

Abstract

Although the presence of coronary artery calcium (CAC) has been associated with the prevalence and incidence of coronary heart disease (CHD), it is unclear if this association has a threshold or a continuous relation. The aim of this research was to explore the relation between CAC, as detected by electron beam tomography (EBT), and CHD in a cross-sectional study of women and men who presented to a single center for elective screening with EBT from 1995 to 1998. Of 17,967 participants, patients with CHD had higher CAC levels than those without CHD. Using subjects without CAC as the referent group, the odds ratios for prevalent CHD increased significantly across increasing quartiles of CAC in the overall population and in both genders. In a subset of the population, after adjusting for CHD risk factors, CAC scores in the fourth quartile were associated with an odds ratio of 33.8 (p <0.001) for prevalent CHD. Among patients with and without CHD, men were more likely than women to have detectable CAC (58.1% vs 28.3% and 96.1% vs 68.9% respectively, p <0.001 for each); the prevalence of detectable CAC increased with age and was higher in men than in women. There was an increased risk for prevalent CHD at all levels of CAC >0, with the greatest increase in risk occurring in patients with CAC scores >95. These observations support the potential of EBT as a sensitive test for detection of CHD1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24.

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Cited by (42)

Coronary Artery Calcium Imaging in the ROBINSCA Trial: Rationale, Design, and Technical Background
2018, Academic Radiology
To describe the rationale, design, and technical background of coronary artery calcium (CAC) imaging in the large-scale population-based cardiovascular disease screening trial (Risk Or Benefit IN Screening for CArdiovascular Diseases [ROBINSCA]).
First, literature search was performed to review the logistics, setup, and settings of previously performed CAC imaging studies, and current clinical CAC imaging protocols of participating centers in the ROBINSCA trial were evaluated. A second literature search was performed to evaluate the impact of computed tomography parameter settings on CAC score.
Based on literature reviews and experts opinion an imaging protocol accompanied by data management protocol was created for ROBINSCA. The imaging protocol should consist of a fixed tube voltage, individually tailored tube current setting, mid-diastolic electrocardiography-triggering, fixed field-of-view, fixed reconstruction kernel, fixed slice thickness, overlapping reconstruction and without iterative reconstruction. The analysis of scans is performed with one type and version of CAC scoring software, by two dedicated and experienced researchers. The data management protocol describes the organization of data handling between the coordinating center, participating centers, and core analysis center.
In this paper we describe the rationale and technical considerations to be taken in developing CAC imaging protocol, and we present a detailed protocol that can be implemented for CAC screening purposes.
Progression of CAC Score and Risk of Incident CVD
2016, JACC: Cardiovascular Imaging
The authors sought to determine the relative contributions of baseline coronary artery calcification (CAC), follow-up CAC, and CAC progression on incident cardiovascular disease (CVD).
Repeat CAC scanning has been proposed as a method to track progression of total atherosclerotic burden. However, whether CAC progression is a useful predictor of future CVD events remains unclear.
This was a prospective observational study of 5,933 participants free of CVD who underwent 2 examinations, including CAC scores, and subsequent CVD event assessment. CAC progression was calculated using the square root method. The primary outcome was total CVD events (CVD death, nonfatal myocardial infarction, nonfatal atherosclerotic stroke, coronary artery bypass surgery, percutaneous coronary intervention). Secondary outcomes included hard CVD events, total coronary heart disease (CHD) events, and hard CHD events.
CAC was detected at baseline in 2,870 individuals (48%). The average time between scans was 3.5 ± 2.0 years. After their second scan, 161 individuals experienced a total CVD event during a mean follow-up of 7.3 years. CAC progression was significantly associated with total CVD events (hazard ratio: 1.14, 95% confidence interval: 1.01 to 1.30 per interquartile range; p = 0.042) in the model including baseline CAC, but the contribution of CAC progression was small relative to baseline CAC (chi-square 4.16 vs. 65.92). Furthermore, CAC progression was not associated with total CVD events in the model including follow-up CAC instead of baseline CAC (hazard ratio: 1.05, 95% confidence interval: 0.92 to 1.21; p = 0.475). A model that included follow-up CAC alone performed as well as the model that included baseline CAC and CAC progression.
Although CAC progression was independently, but modestly, associated with CVD outcomes, this relationship was no longer significant when including follow-up CAC in the model. These findings imply that if serial CAC scanning is performed, the latest scan should be used for risk assessment, and in this context, CAC progression provides no additional prognostic information.
Ideal Cardiovascular Health Metrics and Coronary Artery Calcification in Northern Chinese Population: A Cross-sectional Study
2016, Biomedical and Environmental Sciences
Coronary artery calcification (CAC) is a well-established risk predictor of coronary heart disease events and is recognized as an indicator of subclinical atherosclerosis.
A cross-sectional study consisting of 2999 participants aged ≥40 years from the Jidong community of Tangshan City, an industrial and modern city of China, was conducted between 2013 and 2014 to examine the association between the ideal cardiovascular health (CVH) metrics and CAC. The ideal CVH metrics were determined based on the definition of the American Heart Association (AHA). The participants were then grouped into 4 categories according to the quartiles of their CVH metric scores as follows: first quartile (0-2), second quartile (3), third quartile (4), and fourth quartile (5-7). CAC was assessed by using high-pitch dual-source CT, and patients were identified based on thresholds of 0, 10, 100, or 400 Agatston units, as per common practice.
The prevalence of subclinical atherosclerosis was 15.92%, 13.85%, 6.76%, and 1.93%, determined by using the CAC scores at thresholds of 0, 10, 100, and 400 Agatston units, respectively. Compared with the group in the first quartile, the other three CVH groups had a lower odds ratio of CAC >0 after adjusting for age, sex, income level, education level, and alcohol use in the logistic regression analysis. The odds ratios in these groups were 0.86 [95% confidence interval (CI), 0.63-1.17; P<0.05], 0.75 (95% CI, 0.55-1.02; P<0.05), and 0.49 (95% CI, 0.35-0.69; P<0.05), respectively. These associations of CAC with the CVH metrics were consistent when different CAC cutoff scores were used (0, 10, 100, or 400).
The participants with more-ideal cardiovascular metrics had a lower prevalence of subclinical atherosclerosis determined according to CAC score. Maintaining an ideal cardiovascular health may be valuable in the prevention of atherosclerosis in the general population.
Cardiorespiratory fitness and coronary artery calcification in women
2014, Atherosclerosis
Cardiorespiratory fitness (fitness) has been shown to be inversely associated with coronary heart disease morbidity and mortality. The cardioprotective mechanisms of fitness are not well defined. The goal of this study was to assess the relationship between coronary artery calcification as a measure of atherosclerotic burden and fitness in a large population of generally healthy women.
5341 women ages 40–90 years seen between 1997 and 2007 underwent maximal treadmill exercise testing and coronary artery calcium (CAC) scanning. Fitness was reported in METs estimated from maximal treadmill time, grade, and speed. CAC was characterized dichotomously as CAC = 0 versus CAC > 0, and CAC < 100 versus CAC ≥ 100. Multiple logistic regression models were used to calculate the adjusted odds ratio of any CAC (CAC > 0) and CAC ≥ 100. Fitness was added to these models continuously and categorically based on standard and sample-specific cut-points.
With a mean age of 52.0 years, the overall prevalence of detectable CAC was 19.9% and CAC ≥ 100 was 6.8%. Univariable analysis showed a modest inverse relationship between fitness and CAC > 0 (24% in low fit versus 19% in high fit, p-trend = 0.006), with a similar trend observed for CAC ≥ 100. In multivariable models, age adjustment diminished this association and the relationship was no longer statistically significant after adjustment for traditional risk factors.
The cardioprotective benefit of fitness does not appear to be mediated by an effect independent of traditional risk factors on the development of calcified coronary atherosclerosis as measured by electron beam tomography.
Increased dietary calcium intake is not associated with coronary artery calcification
2012, International Journal of Cardiology
Association between aortic calcification and stable obstructive coronary artery disease
2011, International Journal of Cardiology
Coronary artery calcification (CAC) is correlated with aortic calcification (AC) and predicts coronary atherosclerosis as well as obstructive coronary artery disease (OCAD). This study aims to investigate whether AC predicts OCAD independent of CAC and its incremental value in predicting OCAD with CAC.
Among the consecutive patients who underwent 64-slice multidetector CT (MDCT), we enrolled 120 stable OCAD (luminal narrowing ≥ 50%) patients and 120 controls without OCAD, matched for cardiovascular risk factors. CAC, thoracic AC, and OCAD were determined by MDCT.
The prevalence of AC and CAC were significantly higher in OCAD patients than in controls (64% vs. 48%, p = 0.019; 57% vs. 32%, p < 0.001, respectively). There is a significant correlation between AC and CAC scores in the overall study population (r = 0.528, p < 0.001). In univariate analysis, the odds ratios (ORs) of AC and CAC in predicting OCAD were 1.91 (95% CI, 1.14–3.21) and 2.82 (95% CI, 1.67–4.78), respectively. When an adjustment was made for each other, AC did not maintain a significant association with OCAD, whereas CAC persisted the association (OR, 2.52; 95% CI, 1.42–4.47). Both AC and CAC present as compared to both absent was found to be a more potent predictor for OCAD (OR, 3.37; 95% CI 1.78–6.36, p < 0.001) than CAC alone.
The presence of AC was associated with stable OCAD independently from cardiovascular risk factors, but the association seemed to be based on the close correlation between AC and CAC. However, AC might have an incremental value with CAC for predicting OCAD.

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^☆: This research was supported in part by U.S. Public Health Service research grants R01HL62508 and R01AG06945 from the National Institutes of Health, Bethesda, Maryland, and by contributions from several individuals.

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Comparison of coronary artery calcium detected by electron beam tomography in patients with to those without symptomatic coronary heart disease☆

Abstract

Am J Cardiol

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Am Heart J

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Coronary arterial calcificationa review

Am J Med Sci