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Published on: August 28, 2018
Role of Coronary Calcium for Risk Stratification and Prognostication
Negin Nezarat1, Michael Kim1, Matthew Budoff2
1Division of Cardiology, Los Angeles Bio Medical Research Institute, Harbor UCLA, Torrance, CA, USA.
Insights
An elevated coronary artery calcium (CAC) score indicates advanced atherosclerosis and high cardiovascular disease (CVD) risk. Treatment focuses on lifestyle changes, aspirin, statins, and blood pressure control, not invasive procedures for asymptomatic individuals.
Area of Science:
- Cardiology
- Preventive Medicine
- Radiology
Background:
- Increased coronary artery calcium (CAC) scores are linked to advanced atherosclerosis and elevated cardiovascular disease (CVD) risk.
- Current understanding supports treating high-risk individuals identified by CAC scores with conventional therapies.
Purpose of the Study:
- To outline current guidelines and evidence for managing cardiovascular disease risk based on CAC scores.
- To emphasize appropriate treatment strategies for asymptomatic individuals with elevated CAC scores.
Main Methods:
- Review of existing studies and ACC/AHA 2013 guidelines regarding CAC scoring and CVD risk management.
- Analysis of treatment recommendations based on CAC score thresholds and patient risk stratification.
Main Results:
- Intensified statin therapy is recommended for CAC scores ≥75th percentile or ≥300 Agatston units.
- Revascularization in asymptomatic individuals with preserved left ventricular function does not improve outcomes despite high CAC scores.
Conclusions:
- CAC scoring aids in identifying high-risk individuals for aggressive CVD management.
- Treatment should prioritize lifestyle modifications, aspirin, statins, and blood pressure control over invasive procedures for asymptomatic patients.
Opinion Statement:
A multitude of studies now support the understanding that an increased coronary artery calcium (CAC) score represents advanced atherosclerosis and high risk for cardiovascular disease (CVD) and, as such, should be treated with conventional therapies for those considered high risk. Data is now available to guide treatment with aspirin, statins, and lifestyle management. The new ACC/AHA 2013 guidelines support intensifying statin therapy when the CAC is ≥75th percentile for age, sex, and ethnicity/race or when the calcium score is ≥300 Agatston units. This allows for aggressive management of those at the highest risk, matching intensity of therapy with intensity of risk. Most importantly, the asymptomatic person rarely needs to undergo evaluation for obstructive disease, even when CAC scores are high, as revascularization with percutaneous coronary interventions does not improve outcomes in asymptomatic persons with preserved left ventricular function. Treatment should be relegated to improvement in lifestyle, diet, exercise, aspirin, statins, and blood pressure control.
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