Prevalence and Prognostic Implications of Coronary Artery Calcification in Low-Risk Women: A Meta-analysis

Area of Science:

• Cardiology
• Preventive Medicine
• Medical Imaging

Background:

• Current cardiovascular disease (CVD) prevention guidelines offer limited guidance on using coronary artery calcium (CAC) testing for women at low risk.
• The utility of CAC testing in refining CVD risk stratification for this population remains unclear.

Purpose of the Study:

• To evaluate the effectiveness of CAC testing in estimating and stratifying CVD risk among women initially classified as low risk.
• To determine if CAC adds prognostic value beyond established risk factors.

Main Methods:

• A meta-analysis of 5 large population-based cohorts including women with a 10-year atherosclerotic CVD (ASCVD) risk below 7.5%.
• Data from Dallas Heart Study, Framingham Heart Study, Heinz Nixdorf Recall study, Multi-Ethnic Study of Atherosclerosis, and Rotterdam Study were pooled.
• Coronary artery calcium (CAC) scores were assessed using computed tomography, and incident ASCVD events were tracked over a median follow-up of 7.0 to 11.6 years.

Main Results:

• In 6739 low-risk women, 36.1% had detectable CAC (CAC > 0).
• Presence of CAC was associated with a more than twofold increased risk of ASCVD events (HR, 2.04; 95% CI, 1.44-2.90).
• Incorporating CAC into risk models improved risk prediction accuracy (C statistic increased from 0.73 to 0.77; cNRI = 0.20).

Conclusions:

• CAC is prevalent in approximately one-third of low-risk women and identifies individuals with significantly higher ASCVD risk.
• CAC testing offers a modest improvement in prognostic accuracy compared to traditional risk factors alone.
• Further research is warranted to determine the clinical utility and cost-effectiveness of CAC testing in this demographic.