When Does a Calcium Score Equate to Secondary Prevention?: Insights From the Multinational CONFIRM Registry

Area of Science:

• Cardiology
• Preventive Medicine
• Medical Imaging

Background:

• Elevated coronary artery calcium (CAC) scores in individuals without a history of atherosclerotic cardiovascular disease (ASCVD) are linked to increased cardiovascular risk.
• Determining the threshold for aggressive risk factor management in this population is crucial for effective secondary prevention.

Purpose of the Study:

• To identify the specific CAC score level at which individuals without prior ASCVD should receive aggressive cardiovascular risk factor treatment comparable to patients with established ASCVD.
• To ascertain the CAC score at which risk is equivalent to existing ASCVD.

Main Methods:

• A multinational cohort study using the CONFIRM registry compared ASCVD event rates in individuals with and without a history of ASCVD.
• Individuals were categorized by CAC scores (0, 1-100, 101-300, >300) and compared to those with established ASCVD.
• Kaplan-Meier and Cox proportional hazards regression analyses assessed major adverse cardiovascular events (MACE), MI, revascularization, and mortality.

Main Results:

• A total of 4,949 individuals (4,511 without ASCVD, 438 with ASCVD) were analyzed over a median follow-up of 4 years.
• MACE rates increased with higher CAC scores, with rates for CAC >300 comparable to those with established ASCVD.
• Individuals with CAC scores <300 demonstrated substantially lower event rates.

Conclusions:

• Coronary artery calcium scores greater than 300 confer a risk of MACE and its components equivalent to established ASCVD.
• This finding supports the consideration of intensive preventive strategies for individuals with CAC >300, even without a prior ASCVD event.
• Understanding CAC risk equivalence aids in tailoring preventive approaches for secondary prevention populations.