Related Experiment Video
Updated: Oct 28, 2025
Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
The Added Value of Coronary Calcium Score in Predicting Cardiovascular Events in Familial Hypercholesterolemia
Antonio Gallo1, Leopoldo Pérez de Isla2, Sybil Charrière3
1Department of Endocrinology and Prevention of Cardiovascular Disease, Institute of Cardio Metabolism and Nutrition, La Pitié-Salpêtrière Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France; Laboratoire d'imagerie Biomédicale, Institut National de la Santé de la Recherche Médicale (INSERM) 1146, Centre National de la Recherche Scientifique 7371, Sorbonne University, Paris, France.
Insights
Coronary artery calcium (CAC) scoring significantly enhances cardiovascular risk prediction in heterozygous familial hypercholesterolemia (HeFH). Adding CAC score to existing risk equations improves atherosclerotic cardiovascular disease (ASCVD) prediction, aiding better patient stratification.
Area of Science:
- Cardiology
- Preventive Medicine
- Medical Imaging
Background:
- Cardiovascular risk equations often lack precision for heterozygous familial hypercholesterolemia (HeFH) patients.
- The high variability in HeFH phenotypes necessitates improved risk stratification tools.
- Coronary artery calcium (CAC) scoring may offer enhanced accuracy in predicting atherosclerotic cardiovascular disease (ASCVD) risk.
Purpose of the Study:
- To evaluate the incremental value of CAC score in cardiovascular risk prediction within the SAFEHEART registry.
- To assess if CAC score improves the SAFEHEART risk equation (SAFEHEART-RE) for predicting ASCVD in HeFH patients.
- To determine the impact of CAC score on risk stratification for ASCVD in a primary prevention HeFH cohort.
Main Methods:
- Analysis of data from 1,624 primary prevention HeFH patients from the French (REFERCHOL) and Spanish (SAFEHEART) registries.
- Utilized probability-weighted Cox proportional hazards models to estimate hazard ratios (HRs).
- Employed Area Under the Curve (AUC) and Net Reclassification Improvement (NRI) to quantify the added predictive value of CAC score to the SAFEHEART-RE for ASCVD.
Main Results:
- A CAC score >100 was associated with a significantly increased HR (32.05) for developing ASCVD compared to a CAC score of 0.
- CAC score alone demonstrated good performance in ASCVD prediction (AUC: 0.860).
- The addition of log(CAC + 1) to SAFEHEART-RE significantly improved ASCVD prediction (AUC: 0.884 vs. 0.793; P < 0.001), with a 45.4% NRI.
Conclusions:
- CAC score is a valuable tool for improving cardiovascular risk stratification in HeFH patients.
- The integration of CAC scoring enhances the prediction of ASCVD in individuals with HeFH, even those treated with statins.
- CAC scoring offers a significant improvement in identifying high-risk individuals within the HeFH population.
Objectives:
This study aimed at investigating the additional contribution of coronary artery calcium (CAC) score to SAFEHEART (Spanish Familial Hypercholesterolemia Cohort Study) risk equation (SAFEHEART-RE) for cardiovascular risk prediction in heterozygous familial hypercholesterolemia (HeFH).
Background:
Common cardiovascular risk equations are imprecise for HeFH. Because of the high phenotype variability of HeFH, CAC score could help to better stratify the risk of atherosclerotic cardiovascular disease (ASCVD).
Methods:
REFERCHOL (French Registry of Familial Hypercholesterolemia) and SAFEHEART are 2 ongoing national registries on HeFH. We analyzed data from primary prevention HeFH patients undergoing CAC quantification. We used probability-weighted Cox proportional hazards models to estimate HRs. Area under the receiver-operating characteristic curve (AUC) and net reclassification improvement (NRI) were used to compare the incremental contribution of CAC score when added to the SAFEHEART-RE for ASCVD prediction. ASCVD was defined as coronary heart disease, stroke or transient ischemic attack, peripheral artery disease, resuscitated sudden death, and cardiovascular death.
Results:
We included 1,624 patients (mean age: 48.5 ± 12.8 years; men: 45.7%) from both registries. After a median follow-up of 2.7 years (interquartile range: 0.4-5.0 years), ASCVD occurred in 81 subjects. The presence of a CAC score of >100 was associated with an HR of 32.05 (95% CI: 10.08-101.94) of developing ASCVD as compared to a CAC score of 0. Receiving-operating curve analysis showed a good performance of CAC score alone in ASCVD prediction (AUC: 0.860 [95% CI: 0.853-0.869]). The addition of log(CAC + 1) to SAFEHEART-RE resulted in a significantly improved prediction of ASCVD (AUC: 0.884 [95% CI: 0.871-0.894] for SAFEHEART-RE + log(CAC + 1) vs AUC: 0.793 [95% CI: 0.779-0.818] for SAFEHEART-RE; P < 0.001). These results were confirmed also when considering only hard cardiovascular endpoints. The addition of CAC score was associated with an estimated overall net reclassification improvement of 45.4%.
Conclusions:
CAC score proved its use in improving cardiovascular risk stratification and ASCVD prediction in statin-treated HeFH.
More Related Videos
06:57Author Spotlight: Advancing Cardiovascular Imaging - Introducing the Spatially Weighted Calcium Score for Early Disease Detection
Published on: September 22, 2023
11:30A Semi-Automated and Reproducible Biological-Based Method to Quantify Calcium Deposition In Vitro
Published on: June 2, 2022
Related Concept Videos
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:26Coronary Artery Disease IV: Preventive Measures
01:30Coronary Artery Disease I: Introduction
01:26Coronary Artery Disease II: Pathophysiology
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:27Coronary Artery Disease V: Interprofessional Care