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Published on: September 22, 2023
Discrepancy between coronary artery calcium score and HeartScore in middle-aged Danes: the DanRisk study
Axel C P Diederichsen1, Niels Peter Sand, Bjarne Nørgaard
1Department of Cardiology, Odense University Hospital, Denmark. axel.diederichsen@ouh.regionsyddanmark.dk
Insights
Coronary artery calcification (CAC) is common in healthy individuals, even those with low HeartScore risk. Conversely, many high-risk individuals lack CAC, indicating limitations in current risk assessment models.
Area of Science:
- Cardiology
- Preventive Medicine
- Medical Imaging
Background:
- Coronary artery calcification (CAC) is a recognized risk marker for cardiovascular events.
- Previous studies have not directly compared CAC with the established HeartScore risk prediction model.
Purpose of the Study:
- To investigate the prevalence of CAC in a middle-aged Danish population.
- To compare the findings of CAC screening with the risk stratification provided by the HeartScore model.
Main Methods:
- A random sample of 1825 middle-aged individuals (50 or 60 years) was invited for screening.
- HeartScore was calculated based on traditional risk factors (gender, age, smoking, blood pressure, cholesterol).
- Coronary artery calcification (CAC) was quantified using non-contrast cardiac CT scans (Agatston U).
Main Results:
- Out of 1156 participants, 37% with a low HeartScore (<5%) showed evidence of CAC.
- Conversely, 32% of individuals with a high HeartScore had no detectable CAC.
- Both high HeartScore and the presence of CAC were more prevalent in men than in women.
Conclusions:
- Coronary artery calcification is prevalent in seemingly healthy middle-aged individuals with low predicted cardiovascular risk.
- A significant proportion of individuals identified as high-risk by HeartScore did not exhibit CAC.
- The clinical implications of these discrepancies for treatment and prognosis require further investigation.
Background:
Coronary artery calcification (CAC) is an independent and incremental risk marker. This marker has previously not been compared to the HeartScore risk model.
Design:
A random sample of 1825 citizens (men and women, 50 or 60 years of age) was invited for screening.
Methods:
Using the HeartScore model, the 10-year risk of fatal cardiovascular events based on gender, age, smoking, systolic blood pressure, and total cholesterol was estimated. A low risk was defined as <5%. The CAC score was calculated from a non-contrast enhanced cardiac-CT scan and given in Agatston U.
Results:
A total of 1257 (69%) of the invited subjects were interested in the screening. Due to previous cardiovascular disease or diabetes mellitus, 101 were excluded. Of the remaining 1156, 47% were men and 53% women; one half were 50 years old and the other half 60 years old. A low HeartScore was found in 901 of which 334 (37%) had CAC. A high HeartScore was recorded in 251 of which 80 (32%) did not have any CAC. High HeartScores and CAC were significantly more common in males than females.
Conclusions:
CAC is common in healthy middle-aged Danes with a low HeartScore, and, on the contrary, high-risk subjects very frequently do not have CAC. The therapeutic and prognostic implications of these observations remain to be clarified.
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