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Heterogeneity in the Association Between the Presence of Coronary Artery Calcium and Cardiovascular Events: A
Kosuke Inoue1, Teresa E Seeman2,3, Tamara Horwich4
1Department of Social Epidemiology, Graduate School of Medicine, Kyoto University, Japan (K.I.), UCLA David Geffen School of Medicine.
Circulation
|October 31, 2022
Summary
Coronary artery calcium (CAC) screening can significantly increase cardiovascular disease (CVD) risk prediction, even in individuals with initially low atherosclerotic CVD (ASCVD) risk. This highlights the value of CAC testing across diverse risk groups.
Area of Science:
- Cardiology
- Preventive Medicine
- Biostatistics
Background:
- Coronary artery calcium (CAC) is a key predictor of cardiovascular disease (CVD).
- Identifying individuals who benefit most from CAC screening is crucial due to resource limitations.
- Evidence on how CAC's impact on CVD varies by individual characteristics is limited.
Purpose of the Study:
- To investigate the heterogeneity in the association between positive CAC and incident CVD.
- To evaluate individual-level CVD risk increases associated with CAC > 0.
- To compare CAC-based risk increases with traditional ASCVD risk scores.
Main Methods:
- A cohort study using MESA data of adults aged ≥45 without prior CVD.
- Propensity score matching (1:1 ratio) was applied.
- A machine learning causal forest model analyzed heterogeneity and predicted 10-year CVD risk increases.
Main Results:
- CAC > 0 showed heterogeneous associations with incident CVD across individuals.
- A dose-response relationship was observed between CAC > 0 and higher 10-year ASCVD risk.
- Nearly 70% of low ASCVD risk individuals experienced a ≥2.5% CVD risk increase with CAC > 0, often associated with male sex, Hispanic ethnicity, and unfavorable risk factors.
Conclusions:
- The increase in CVD risk from positive CAC is not uniform across individuals.
- CAC screening is valuable for low ASCVD risk individuals, as many show a substantial risk increase.
- Future research should explore CAC screening strategies incorporating both absolute ASCVD risk and expected risk increase.
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