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Cardiovascular Risk Factors and Coronary Calcification in a Middle-aged Dutch Population: The ImaLife Study
Congying Xia1, Marleen Vonder2, Grigory Sidorenkov2
1Departments of Radiology.
Insights
Coronary artery calcium (CAC) is common in middle-aged adults, particularly men. Adding CAC scoring to risk assessments like SCORE could improve cardiovascular risk classification, especially for men initially categorized as high-risk.
Area of Science:
- Cardiology
- Public Health
- Medical Imaging
Background:
- Cardiovascular disease remains a leading cause of mortality worldwide.
- Accurate risk stratification is crucial for effective primary prevention strategies.
- Coronary artery calcium (CAC) scoring is an emerging tool for assessing subclinical atherosclerosis.
Purpose of the Study:
- To evaluate the prevalence of coronary artery calcium (CAC) in a middle-aged Dutch population.
- To examine the association between CAC and traditional cardiovascular risk factors.
- To assess the utility of CAC in refining cardiovascular risk stratification using the Systematic COronary Risk Evaluation (SCORE) system.
Main Methods:
- Analysis of 4083 participants (aged 45-60) from the population-based ImaLife study.
- Quantification of CAC using noncontrast cardiac CT scans.
- Comparison of CAC distribution with SCORE risk categories and estimation of population attributable fractions (PAFs) for risk factors.
Main Results:
- CAC was present in 54.5% of men and 26.5% of women.
- A significant proportion of men classified as high-risk by SCORE (≥5%) had no detectable CAC (26.9%).
- Hypertension, hypercholesterolemia, and obesity were significant contributors to CAC prevalence, with substantial population attributable fractions.
Conclusions:
- CAC is highly prevalent in middle-aged men and common in women.
- CAC scoring can reclassify cardiovascular risk, potentially downstaging high-risk individuals identified by SCORE alone.
- Integrating CAC assessment into risk prediction models may enhance personalized cardiovascular risk management.
Purpose:
To assess the presence of coronary artery calcium (CAC) and its association with cardiovascular risk factors and Systematic COronary Risk Evaluation (SCORE) risk in a middle-aged Dutch population.
Methods:
Classic cardiovascular risk factors and CAC were analyzed in 4083 participants aged 45 to 60 years (57.9% women) from the population-based ImaLife study. CAC scores were quantified on noncontrast cardiac CT scans. Age-specific and sex-specific distribution of CAC categories (0, 1 to 99, 100 to 299, ≥300) and percentiles were determined. SCORE risk categories (<1%, ≥1% to 5%, and ≥5%) were compared with CAC distribution. Population attributable fractions (PAFs) of classic risk factors for CAC were estimated.
Results:
CAC was present in 54.5% male and 26.5% female participants. The percentage of individuals with CAC increased with increasing age. Mean SCORE was 2.0% in men and 0.7% in women. In SCORE <1%, 32.7% of men and 17.1% of women had CAC. In men with SCORE ≥5%, 26.9% had no CAC. Only 0.1% of women had SCORE ≥5%. PAF of classic risk factors for CAC was 18.5% in men and 31.4% in women. PAF was highest for hypertension (in men 8.0%, 95% confidence interval, 4.2%-11.8%; in women 13.1%, 95% confidence interval, 7.9%-18.2%) followed by hypercholesterolemia and obesity.
Conclusion:
In this middle-aged cohort, more than half of the men and a quarter of the women had CAC. One out of 4 men at high risk (SCORE ≥5%) could be placed into a lower risk category owing to absence of CAC. Thus, adding CAC scoring to SCORE could have considerable effect on cardiovascular risk classification. Elimination of exposure to classic risk factors could reduce limited proportion of CAC in a middle-aged population.
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