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Updated: Aug 12, 2026
Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Cardiovascular Event Prediction and Risk Reclassification by Coronary, Aortic, and Valvular Calcification in the
Udo Hoffmann1, Joseph M Massaro2, Ralph B D'Agostino2
1Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA uhoffmann@partners.org.
Insights
Coronary artery calcium (CAC) effectively predicts major coronary heart disease and cardiovascular disease (CVD) events, improving risk assessment beyond traditional factors in asymptomatic individuals.
Area of Science:
- Cardiology
- Preventive Medicine
- Medical Imaging
Background:
- Vascular and valvular calcification are potential predictors of cardiovascular events.
- The Framingham Heart Study cohort provided a community-based population for this investigation.
Purpose of the Study:
- To determine if vascular and valvular calcification predict major coronary heart disease, cardiovascular disease (CVD), and all-cause mortality.
- To assess if these calcifications offer predictive value independent of established Framingham risk factors.
Main Methods:
- Cardiac computed tomography was used to measure coronary artery calcium (CAC), thoracic and abdominal aortic calcium, and mitral/aortic valve calcium.
- Multivariate Cox proportional hazards models analyzed associations with endpoints over a median 8-year follow-up.
- C-statistic and net reclassification index evaluated improvements in risk prediction.
Main Results:
- CAC showed the strongest association with major coronary heart disease, followed by major CVD and all-cause mortality, independent of Framingham risk factors.
- Mitral valve calcium was associated with major CVD and all-cause mortality, independent of other factors.
- CAC significantly improved discrimination for coronary heart disease risk (AUC 0.78-0.82) and reclassified two-thirds of intermediate-risk individuals.
Conclusions:
- Coronary artery calcium (CAC) enhances risk prediction for major coronary heart disease and CVD in asymptomatic individuals.
- CAC improves risk reclassification, particularly for those at intermediate risk based on traditional factors.
Background:
We determined whether vascular and valvular calcification predicted incident major coronary heart disease, cardiovascular disease (CVD), and all-cause mortality independent of Framingham risk factors in the community-based Framingham Heart Study.
Methods And Results:
Coronary artery calcium (CAC), thoracic and abdominal aortic calcium, and mitral or aortic valve calcium were measured by cardiac computed tomography in participants free of CVD. Participants were followed for a median of 8 years. Multivariate Cox proportional hazards models were used to determine association of CAC, thoracic and abdominal aortic calcium, and mitral and aortic valve calcium with end points. Improvement in discrimination beyond risk factors was tested via the C-statistic and net reclassification index. In this cohort of 3486 participants (mean age 50±10 years; 51% female), CAC was most strongly associated with major coronary heart disease, followed by major CVD, and all-cause mortality independent of Framingham risk factors. Among noncoronary calcifications, mitral valve calcium was associated with major CVD and all-cause mortality independent of Framingham risk factors and CAC. CAC significantly improved discriminatory value beyond risk factors for coronary heart disease (area under the curve 0.78-0.82; net reclassification index 32%, 95% CI 11-53) but not for CVD. CAC accurately reclassified 85% of the 261 patients who were at intermediate (5-10%) 10-year risk for coronary heart disease based on Framingham risk factors to either low risk (n=172; no events observed) or high risk (n=53; observed event rate 8%).
Conclusions:
CAC improves discrimination and risk reclassification for major coronary heart disease and CVD beyond risk factors in asymptomatic community-dwelling persons and accurately reclassifies two-thirds of the intermediate-risk population.
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