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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Screening for heart disease: C-reactive protein versus coronary artery calcium
Amish A Patel1, Matthew J Budoff
1Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, 1124 W. Carson Street, RB2, Torrance, CA 90502, USA.
Insights
Coronary artery calcification (CAC) shows greater promise than C-reactive protein (CRP) for predicting coronary heart disease (CHD) risk. CAC improves risk prediction models, while CRP data remains inconsistent for CHD assessment.
Area of Science:
- Cardiology
- Preventive Medicine
- Biomarker Research
Background:
- The Framingham model is standard for coronary artery disease (CAD) risk assessment.
- Nontraditional risk factors like C-reactive protein (CRP) and coronary artery calcification (CAC) are explored to enhance CAD prediction.
- CRP is a biomarker of inflammation with inconsistent data for predicting coronary heart disease (CHD).
Purpose of the Study:
- To evaluate the predictive value of CRP and CAC for coronary heart disease (CHD) risk.
- To compare the effectiveness of CAC and CRP in improving existing risk stratification algorithms.
- To determine the clinical relevance of CAC versus CRP in predicting future cardiac events.
Main Methods:
- Review of existing literature comparing CRP and CAC in predicting cardiovascular events.
- Analysis of studies evaluating the improvement in the C-statistic and patient reclassification when adding CRP or CAC to the Framingham risk score.
- Examination of cohorts that assessed both CAC and CRP for future cardiovascular events.
Main Results:
- CAC consistently improves the C-statistic and patient reclassification in risk models for coronary heart disease (CHD).
- CRP data for CHD prediction is inconsistent, with modest reclassification (<10%) and no improvement in the C-statistic.
- Studies comparing both CAC and CRP in the same cohort show significant predictive ability for CAC, but not for CRP.
Conclusions:
- Coronary artery calcification (CAC) is more clinically relevant than CRP for evaluating coronary heart disease (CHD) risk.
- CAC demonstrates a stronger relationship with future cardiac events and improves risk prediction models.
- Further cost-effectiveness studies are needed for CAC due to its higher cost compared to CRP.
Abstract:
The Framingham model has become the standard to assess future risk of coronary artery disease. Several nontraditional risk factors have been suggested to improve risk stratification to provide a new algorithm for predicting coronary heart disease (CHD). Two factors with the most available data include C-reactive protein (CRP) and coronary artery calcification (CAC). CRP, a well-established biomarker of inflammation, has shown very inconsistent data to predict CHD, and no study to date shows improvement in the C-statistic; in addition, reclassification is modest (<10% of patients are reclassified to higher or lower risk categories). CAC seems to hold a greater promise in the prediction of CHD and demonstrates a stronger relationship to future cardiac events, with all studies demonstrating improvement in the C-statistic when added to the Framingham risk score. Measurement of CAC consistently provides reclassification of patients more accurately to the Framingham risk model. Only four studies have evaluated both CAC and CRP in the same cohort for future cardiovascular events, but all of these showed significant prediction for coronary artery disease using CAC and no significant prediction ability for CRP. Current review of the literature available suggests CAC to be more relevant in evaluating CHD in a clinical setting. Given the higher cost of CAC scanning compared with CRP, cost-effectiveness studies are still needed.
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