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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Smoking and obesity predict high-risk plaque by coronary CTA in low coronary artery calcium score (CACS)
Thomas Senoner1, Fabian Plank1, Christian Langer2
1Department of Internal Medicine III- Cardiology, Innsbruck Medical University, Austria.
Insights
In patients with low coronary artery calcium scores (1-99 AU), male gender, smoking, and obesity are key predictors of high-risk plaque. These findings suggest intensifying preventive measures like statins for cardiovascular risk management.
Area of Science:
- Cardiology
- Radiology
- Preventive Medicine
Background:
- Current guidelines recommend statins for coronary artery calcium scores (CACS) > 100 AU.
- Patients with low CACS (1-99 AU) fall into a clinical grey zone regarding statin therapy.
- High-risk plaque (HRP) identified by coronary computed tomography angiography (CCTA) may indicate elevated cardiovascular risk.
Purpose of the Study:
- To determine which cardiovascular risk factors predict HRP in patients with low CACS (1-99 AU).
- To aid clinical decision-making for primary prevention in this patient group.
Main Methods:
- 1003 symptomatic patients with low-to-intermediate risk and CACS 1-99 AU underwent CCTA.
- CCTA analysis included stenosis severity and HRP criteria (e.g., low-attenuation plaque, napkin-ring sign).
- Multivariate regression models assessed the association of major cardiovascular risk factors (smoking, hypertension, family history, dyslipidemia, diabetes, obesity) with HRP.
Main Results:
- Smoking was significantly associated with HRP criteria, including low-attenuation plaque and positive remodeling.
- Male gender was also strongly associated with HRP.
- Obesity predicted low-attenuation plaque, while smoking predicted specific HRP features in males.
Conclusions:
- Male gender, smoking, and obesity are independent predictors of HRP in patients with low CACS (1-99 AU).
- The presence of HRP in this cohort suggests a higher cardiovascular risk.
- Intensification of primary cardiovascular prevention, including statin therapy, is warranted for these patients.
Background:
The AHA recommends statins in patients with CACS>100 AU. However in patients with low CACS (1-99 AU), no clear statement is provided, leaving the clinician in a grey-zone. High-risk plaque (HRP) criteria by coronary CTA are novel imaging biomarkers indicating a higher a-priori cardiovascular (CV) risk, which could help for decision-making. Therefore the objective of our study was to identify which CV-risk factors predict HRP in patients with low CACS 1-99.
Methods:
1003 symptomatic patients with low-to-intermediate risk, a clinical indication for coronary computed tomography angiography (CCTA) and who had a coronary artery calcium score (CACS) between 1 and 99 AU, were enrolled. CCTA analysis included: stenosis severity and HRP-criteria: low-attenuation plaque (LAP <30HU, <60HU and <90HU) napkin-ring-sign, spotty calcification and positive remodeling. Multivariate regression models were created for predicting HRP-criteria by the major 5 cardiovascular risk factors (CVRF) (smoking, arterial hypertension, positive family history, dyslipidemia, diabetes) and obesity (BMI>25 kg/m2).
Results:
304 (33.5%) were smokers. 20.4% of smokers had HRP compared with only 14.9% of non-smokers (p = 0.045). Male gender was associated with HRP (p < 0.001). Smoking but not the other 5 CVRF had the most associations with HRP-criteria (LAP<60HU/≥2 criteria:OR 1.59; 95%CI:1.07-2.35), LAP<90HU (OR 1.57; 95%CI:1.01-2.43), Napkin-Ring-Sign (OR 1.78; 95%CI:1.02-3.1) and positive remodelling (OR 1.54; 95%CI:1.09-2.19). Smoking predicted fibrofatty LAP<90HU in males only. Obesity predicted LAP<60HU in both females and males.
Conclusions:
In patients with low CACS 1-99AU, male gender, smoking and obesity, but not the other CVRF predict HRP. These patients would rather benefit from intensification of primary CV-prevention measures such as statins.
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