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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Coronary artery calcium score in high-risk asymptomatic women in Saudi Arabia
Ahmed Fathala1, Saleh Alreshoodi, Mashael Al Rujaib
1Ahmed Fathala MD, Department of Radiology,, King Faisal Specialist Hospital and Research Centre,, MBC 28, Riyadh 11211, Saudi Arabia, T: +966-11-4647272 ext 33812, ahm35799@hotmail.com.
Insights
Coronary artery calcification (CAC) scores are significantly higher in Saudi women compared to US data. Current international percentiles underestimate atherosclerosis severity in this population.
Area of Science:
- Cardiovascular Imaging
- Atherosclerosis Research
- Public Health
Background:
- Coronary artery calcification (CAC) is a marker of atherosclerosis and coronary artery disease (CAD).
- No prior data existed on CAC prevalence in high-risk Saudi women.
- The study aimed to assess CAC scores in this underrepresented demographic.
Purpose of the Study:
- To determine the prevalence and percentiles of CAC scores in high-risk, asymptomatic Saudi women.
- To compare these findings with age-specific CAC percentiles from a US population-based study.
- To evaluate the applicability of international CAC data to the Saudi population.
Main Methods:
- Retrospective analysis of CAC scores (CACS) from 918 women screened between 2011 and 2015.
- Participants were asymptomatic but had one or more CAD risk factors (diabetes, hypertension, etc.).
- CT scans were interpreted by experienced professionals; data compared to US benchmarks.
Main Results:
- Saudi women exhibited significantly higher 75th and 90th percentile CACS compared to US data.
- Baseline CAD risk factors were more prevalent in the Saudi cohort.
- Age and diabetes were identified as independent predictors of CAC severity.
Conclusions:
- CAC percentiles in Saudi women are higher than international standards.
- Existing international percentiles are not suitable for Saudi women and may underestimate atherosclerosis.
- A large, population-based study is needed to establish local CAC percentiles for improved CAD management.
Background And Objective:
Coronary artery calcification (CAC) is indicated by calcium deposits in the coronary artery wall. Calcification is a component of atherosclerosis and coronary artery disease. Currently, there are no data on calcification in Saudi women at high risk of coronary artery disease. The aim of this study was to investigate the prevalence and percentiles of CAC score in high-risk asymptotic women in Saudi Arabia with comparison of age-specific CAC percentiles derived from large population-based published study in the United States.
Design And Setting:
Retrospective analysis of CAC scores (CACS) at a single tertiary care center.
Methods:
Between January 2011 and April 2015, women referred for CAC screening because of the presence of one or more CAD risk factors were enrolled in the study. CT scans were interpreted by an experienced radiographic technologist, and confirmed by a radiologist.
Results:
The study sample consisted of 918 women, mean (SD) age of 55 (11) years. All patients were asymp.tomatic and referred by their primary care physician or cardiologist for CAC screening because presence of one or more CAD risks factors. CAD risk factors included diabetes, hypertension, hypercholesterolemia, family history of CAD, and obesity. Baseline CAD risk factors were remarkably higher than in the US comparator group. CACS for 25th, 50th, 75th, and 90th percentiles were calculated. The 75th and 90th CACS percentiles in Saudi women were significantly higher than the US percentiles. Age and diabetes are the most independent predictor of severity of CAC.
Limitations:
A potential bias due to sample collection because data was from a single tertiary care center, the study was retrospective and the sample size was small.
Conclusion:
There are significantly higher CACS percentiles in Saudi women compared with international data. Application of available published percentiles to a local population is not applicable and underestimates the severity of subclinical atherosclerosis. A large local population-based study is warranted to establish local CACS percentiles for a better understanding CAD screening, diagnosis, and treatment.
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