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coronary artery calcium (CAC testing)

Indications: - assessment of asymptomatic coronary artery disease - reasonable test in patients with intermediate risk of coronary artery disease [1,25]* - not recommended for patients at low or high risk [1] - may identify subset of patients who would likely derive benefit from aspirin &/or statin therapy [2,25,27] - might help stratify cardiovascular risk in patients with diabetes mellitus type 2 [3,4] * Framingham risk score 10-20% [1] * adults 40-75 years without diabetes, with LDL 170-190 mg/dL, & 10-year cardiovascular risk of 7.5-20% [12] Contraindications: - coronary computed tomography angiography of no benefit in calibrating intensity of preventive therapy in patients with diabetes mellitus [13] Procedure: A computed tomography procedure - electron beam CT or spiral CT - coronary artery calcium is measured by its radio-opacity - scores of < 1 consistent with no calcification - scores of 1-10 constent with low calcification - scores of > 10 consistent with high caclification Advantages: - scores are predictive of cardiovascular risk - better than polygenic risk score Disadvantages: - radiation exposure - does not provide data on coronary artery luminal narrowing Clinical significance: - absence of coronary artery calcification (score = 0) associated with low risk for cardiovascular events [1] - no statin needed if intermediate 10-year cardiovascular risk ACC/AHA 7.5%-20%, USPSTF 10%-20% & asymptomatic [1] - positive correlation between coronary artery calcium volume & cardiovascular risk [4] - negative correlation between coronary artery calcium density & cardiovascular risk [4] - coronary artery calcium scores predict all cause mortality [6] - coronary artery calcium noted incidentally on chest CT increases with age [30] - men have higher prevalence of detectable oronary artery calcium than women - non hispanic white men with highest prevalence, > 50% by age 50-54 years - coronary artery calcium at age 40 associated with increased risk for coronary artery events in the next 10 years [10] - coronary artery calcium scores of zero less predictive of cardiovascular risk in patients < 40 year than in older patients [28] - coronary artery calcium scores can improve cardiac risk assessment in intermediate-risk patients [1] - very high coronary artery calcium scores (> 1000) associated with increased risk for cardiovascular events (RR=4.7) & all-cause mortality (RR=1.9) [24] - coronary artery calcification present in 36% of women with calculated 10 year cardiovascular risk of < 7.5% [9] - harm vs benefit of testing low risk women of concern [9] - coronary artery calcification assessed by computed tomography may have predictive value for myocardial infarction in patients with at least 1 traditional risk factor (see coronary artery disease). [14] - the absence of coronary artery calcification does not exclude obstructive coronary artery disease in symptomatic people who are referred for angiography [15] - overall sensitivity of a coronary artery calcification score of 0 for predicting absence of coronary artery disease is 45% - may be useful for identifying patients with chest pain who can be discharged home without further testing - lack of coronary artery calcification identifies low-risk patients [16] - may be useful for reclassifying patients with intermediate-risk of acute coronary syndrome, myocardial infarction &/or sudden cardiac death [17,18] - predicts stroke risk in people at low to intermediate risk [19] - incidental finding of coronary artery calcification on CT of thorax allegedly has clinical significance [20] - authors suggest a statin plus an aspirin [21] - predicts 10-15 year mortality [21] - coronary artery calcification associated with higher levels of lifelong physical exercise in men [22] - suggested to be a benign condition [22] - high levels of physical activity (>= 3000 MET-min/week) associated with prevalent coronary artery calcium, but not associated with increased mortality even with high coronary artery calcium [23] - positive, graded association between physical activity & prevalence & progression of coronary artery calcium, regardless of baseline scores [26] - calcification may stabilize coronary artery atherosclerotic lesions Management: - if coronary artery calcium score is >= 100, a statin should be initiated [12] Notes: - used to assess air pollution as cardiovascular risk factor [8] - arterial calcification noted on digital mammography predicts coronary artery calcium [7]* * article withdrawn at request of author(s) &/or editor

Related

cardiac computed tomography angiography; coronary computed tomography angiography; CT angiography (CCTA) coronary artery calcification

General

CT of heart

References

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