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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Interplay of Risk Factors and Coronary Artery Calcium for CHD Risk in Young Patients
Martin Bødtker Mortensen1, Omar Dzaye2, Henrik Bødtker3
1Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Insights
Coronary artery calcium (CAC) and risk factors strongly predict coronary heart disease (CHD) in young adults. Even low CAC indicates high risk when combined with risk factors, emphasizing simultaneous assessment.
Area of Science:
- Cardiology
- Preventive Medicine
- Medical Imaging
Background:
- The relationship between cardiovascular risk factors, coronary artery calcium (CAC), and coronary heart disease (CHD) in younger populations (≤45 years) remains unclear.
- Understanding these predictors is crucial for early risk stratification and intervention in young symptomatic patients.
Purpose of the Study:
- To investigate the prevalence, predictors, and impact of CAC on obstructive coronary artery disease (CAD) and future CHD risk in young patients.
- To analyze the combined influence of CAC and traditional risk factors on cardiovascular outcomes.
Main Methods:
- A cohort of 3,691 symptomatic patients aged 18-45 years from the Western Denmark Heart Registry underwent coronary computed tomographic angiography.
- Coronary heart disease events, including myocardial infarction and late revascularization, were tracked over a median follow-up of 4.1 years.
Main Results:
- Coronary artery calcium prevalence increased significantly with a higher number of risk factors.
- Both obstructive CAD at baseline and future CHD event rates escalated with increasing CAC scores and number of risk factors.
- Patients with >3 risk factors and CAC >10 had a substantially higher CHD event rate (36.3 per 1,000 person-years) compared to those with 0 risk factors and CAC=0 (0.5 per 1,000 person-years).
Conclusions:
- A strong interplay exists between CAC and traditional risk factors in predicting obstructive CAD and future CHD risk among young patients.
- Even a low CAC score is a significant high-risk marker when cardiovascular risk factors are present.
- Simultaneous assessment of risk factors and CAC is vital for accurate risk evaluation in young individuals.
Objectives:
The aim of this study was to examine prevalence, predictors, and impact of coronary artery calcium (CAC) across different risk factor burdens on the prevalence of obstructive coronary artery disease (CAD) and future coronary heart disease (CHD) risk in young patients.
Background:
The interplay of risk factors and CAC for predicting CHD in young patients aged ≤45 years is not clear.
Methods:
The study included 3,691 symptomatic patients (18-45 years of age) from the WDHR (Western Denmark Heart Registry) undergoing coronary computed tomographic angiography. CHD events were myocardial infarction and late revascularization.
Results:
During a median of 4.1 years of follow-up, 57 first-time CHD events occurred. In total, 3,180 patients (86.1%) had CAC = 0 and 511 patients (13.9%) had CAC >0. Presence of CAC increased with number of risk factors (odds ratio: 4.5 [95% CI: 2.7-7.3] in patients with >3 vs 0 risk factors). The prevalence of obstructive CAD at baseline and the rate of future CHD events increased in a stepwise manner with both higher CAC and number of risk factors. The CHD event rate was lowest at 0.5 (95% CI: 0.1-3.6) per 1,000 person-years in patients with 0 risk factors and CAC = 0. Among patients with >3 risk factors, the event rate was 3.1 (95% CI: 1.0-9.7) in patients with CAC = 0 compared with 36.3 (95% CI: 17.3-76.1) in patients with CAC >10.
Conclusions:
In young patients, there is a strong interplay between CAC and risk factors for predicting the presence of obstructive CAD and for future CHD risk. In the presence of risk factors, even a low CAC score is a high-risk marker. These results demonstrate the importance of assessing risk factors and CAC simultaneously when assessing risk in young patients.
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