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Role of Coronary Artery Calcium Score of Zero and Other Negative Risk Markers for Cardiovascular Disease: The
Michael J Blaha1, Miguel Cainzos-Achirica2, Philip Greenland2
1From Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, MD (M.J.B., M.C.-A., J.W.M., Z.D., R.S.B., K.N.); Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD (M.C.-A.); Departments of Medicine and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (P.G.); Brigham and Women's Hospital, Boston, MA (R.B.); Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J.B.); Knight Cardiovascular Institute, Oregon Health and Science University, Portland (C.T.S.); Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC (G.L.B.); University of Washington, Seattle (R.A.K.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (M.J.B., M.S.); Center for Healthcare Advancement and Outcomes, and Miami Cardiac and Vascular Institute, Baptist Heath South Florida, Miami (K.N.). mblaha1@jhmi.edu.
A coronary artery calcium score of 0 significantly reduces cardiovascular disease risk. This finding helps identify individuals unlikely to benefit from preventive medications, improving risk assessment.
Area of Science:
- Cardiovascular Disease Research
- Biomarkers and Risk Assessment
- Preventive Cardiology
Background:
- Limited focus on negative cardiovascular disease (CVD) risk markers hinders optimal medical decision-making.
- Diagnostic Likelihood Ratios (DLRs) can quantify risk reduction from negative test results.
Purpose of the Study:
- To compare the effectiveness of 13 negative CVD risk markers in reducing estimated risk.
- To identify which negative markers most accurately reclassify individuals at lower CVD risk.
Main Methods:
- Analysis of 6814 participants from the Multi-Ethnic Study of Atherosclerosis (MESA).
- Comparison of 13 negative risk markers including coronary artery calcium (CAC) score, carotid intima-media thickness, hs-CRP, ABI, and family history.
- Utilized Diagnostic Likelihood Ratios (DLRs) and Net Reclassification Improvement (NRI) analyses, adjusting for traditional CVD risk factors.
Main Results:
- A CAC score of 0 demonstrated the strongest risk reduction (DLR 0.41 for coronary heart disease, 0.54 for CVD).
- Carotid intima-media thickness <25th percentile and absence of family history also showed significant risk reduction.
- NRI analyses confirmed CAC score of 0 provided the most accurate downward risk reclassification.
Conclusions:
- Negative findings from atherosclerosis imaging, especially a CAC score of 0, substantially decrease estimated CVD risk.
- These results can inform clinical discussions about the necessity of preventive pharmacotherapy for individuals with low risk.
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