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Coronary artery calcium scores indicating secondary prevention level risk: Findings from the CAC consortium and

Omar Dzaye1, Alexander C Razavi2, Erin D Michos3

  • 1Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Atherosclerosis
|February 24, 2022
PubMed

Insights

High coronary artery calcium (CAC) scores in primary prevention patients can indicate atherosclerotic cardiovascular disease (ASCVD) mortality risks similar to secondary prevention patients. This suggests a risk continuum between these groups.

Area of Science:

  • Cardiology
  • Preventive Medicine
  • Epidemiology

Background:

  • Coronary artery calcium (CAC) scoring is associated with atherosclerotic cardiovascular disease (ASCVD) risk.
  • The FOURIER trial provided data on ASCVD mortality in a secondary prevention cohort.

Purpose of the Study:

  • To determine CAC scores in primary prevention patients equivalent to ASCVD mortality rates observed in the FOURIER trial.
  • To explore the risk continuum between primary and secondary prevention patients.

Main Methods:

  • Analysis of 20,207 participants from the CAC Consortium aged ≥50 with a 10-year ASCVD risk ≥7.5%.
  • Utilized Poisson regression to model the relationship between CAC and annual ASCVD mortality.
  • Derived equivalent CAC scores based on observed ASCVD mortality rates in FOURIER placebo participants.

Main Results:

  • An annualized ASCVD mortality rate of 0.766 per 100 person-years in FOURIER corresponded to a CAC score of 781 (418-1467).
  • A CAC score of 255 (162-394) matched the ASCVD mortality rate of the lowest-risk FOURIER subgroup.
  • No CAC score replicated the risk of high-risk FOURIER subgroups (e.g., symptomatic PAD, multivessel CAD).

Conclusions:

  • Elevated CAC burden in primary prevention may confer ASCVD mortality risks comparable to stable secondary prevention.
  • Findings support a continuous spectrum of ASCVD risk overlapping between higher-risk primary prevention and stable secondary prevention populations.
Abstract

Keywords:
Coronary artery calciumCoronary artery diseaseRisk assessment

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