Comprehensive coronary risk determination in primary prevention: an imaging and clinical based definition combining computed tomographic coronary artery calcium score and national cholesterol education program risk score
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Updated: Aug 6, 2026
Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Khurram Nasir1, Chandra Vasamreddy, Roger S Blumenthal
1Department of Medicine, University of Pittsburgh, PA, USA.
Insights
Coronary artery calcification (CAC) scoring refines cardiovascular disease risk assessment by integrating imaging data with traditional risk factors. This approach offers a more precise calculation of absolute risk for individuals, improving early detection and treatment strategies.
Area of Science:
- Cardiology
- Radiology
- Preventive Medicine
Background:
- Cardiovascular disease (CVD) is a leading cause of mortality, with coronary heart disease (CHD) responsible for nearly half of CVD deaths.
- Current risk prediction relies on Framingham risk equations, which may lack precision for individuals without traditional atherosclerosis risk factors.
- Identifying subclinical atherosclerotic disease is crucial for accurate risk assessment in asymptomatic individuals.
Purpose of the Study:
- To enhance coronary heart disease (CHD) risk assessment by combining coronary artery calcification (CAC) scoring with Framingham risk profiling.
- To refine absolute risk calculation by integrating imaging (CAC scoring) and clinical data for a more comprehensive individual risk assessment.
- To improve the identification of high-risk individuals who may benefit from aggressive treatment strategies.
Main Methods:
- Utilized computed tomographic "heartscan" (Electron Beam Tomography - EBT) for coronary artery calcification (CAC) scoring.
- Incorporated CAC scores into risk stratification by adjusting chronological age based on percentile thresholds (75th-90th percentile: +10 years; >90th percentile: +20 years).
- For older individuals with a CAC score of 0, assigned an age point score corresponding to younger age groups (men: 40-44 years; women: 55-59 years).
Main Results:
- CAC scoring allows for the inclusion of subclinical disease detection in risk assessment.
- The integration of CAC scores refines the absolute risk calculation beyond traditional risk factors.
- Identified high-risk individuals who may require more aggressive preventive interventions.
Conclusions:
- Combining CAC scoring with Framingham risk profiling provides a more precise and comprehensive assessment of absolute cardiovascular risk.
- CAC scoring is a valuable tool for identifying subclinical atherosclerosis and guiding treatment decisions.
- This integrated approach aids in the early detection and management of individuals at high risk for coronary heart disease.
Abstract:
Cardiovascular disease (CVD) is the leading cause of mortality and a major cause of morbidity. Coronary heart disease (CHD) accounts for nearly half of all CVD deaths. Currently estimation of risk in primary prevention is based on the Framingham risk equations, which inputs traditional risk factors and is helpful in predicting the development of CHD in asymptomatic individuals. However many individuals suffer events in the absence of established risk factors for atherosclerosis and broad based population risk estimations may have little precision when applied to a given individual. To meet the challenge of CHD risk assessment, several tools have been developed to identify atherosclerotic disease in its preclinical stages. This paper aims to incorporate information from coronary artery calcification (CAC) scoring from a computed tomographic "heartscan" (using Electron Beam Tomography (EBT) as the validated prototype) along with current Framingham risk profiling in order to refine risk on an absolute scale by combining imaging and clinical data to affect a more comprehensive calculation of absolute risk in a given individual. For CAC scores above the 75th percentile but <90th percentile, 10 years is added to chronological age, and for CAC scores above the 90th percentile, 20 years is added to current chronological age. Among those in whom a positive CAC score is the norm such as older individuals (men> or =55 years, women> or =65 years) a CAC = 0 will result in an age point score corresponding to the age-group whose median CAC score is zero i.e., 40-44 years for men and 55-59 years for women. The utilization of CAC scores allows the inclusion of sub-clinical disease definition into the context of modifiable risk factors as well as identifies high-risk individuals requiring aggressive treatment.
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