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Published on: June 2, 2022
Coronary artery calcium and sudden cardiac death: current evidence and future directions
Alexander C Razavi1,2, Seamus P Whelton3, Roger S Blumenthal3
1Emory Center for Heart Disease Prevention.
Insights
Coronary artery calcium (CAC) significantly increases sudden cardiac death (SCD) risk in asymptomatic adults. Early detection of CAC via CT aids risk stratification and guides comprehensive prevention strategies for reducing SCD.
Area of Science:
- Cardiology
- Preventive Cardiology
- Medical Imaging
Background:
- Sudden cardiac death (SCD) accounts for up to 80% of cardiac mortality, often linked to coronary heart disease (CHD).
- Subclinical atherosclerosis markers for improved SCD risk prediction remain largely undefined.
- Current risk prediction models may not adequately identify individuals at high risk for SCD.
Approach:
- Reviewing current evidence on coronary artery calcium (CAC) and its association with SCD risk.
- Analyzing observational data linking increasing CAC burden to elevated SCD risk, independent of traditional risk factors.
- Exploring potential mechanisms mediating the relationship between CAC and SCD.
Key Points:
- Higher CAC burden correlates with a stepwise increase in SCD risk, even in asymptomatic individuals without overt atherosclerotic cardiovascular disease (ASCVD).
- A CAC score of at least 100 is associated with a three-fold to five-fold higher SCD risk compared to a CAC score of 0.
- Potential mechanisms include myocardial infarction, cardiac scarring, and exercise-induced ischemia.
Conclusions:
- High CAC burden is a critical risk factor for SCD in asymptomatic middle-aged adults.
- CAC measurement using noncontrast computed tomography enables early CHD risk stratification.
- Prioritizing comprehensive ASCVD prevention strategies is essential for mitigating SCD risk.
Purpose Of Review:
To provide a summary of the current evidence and highlight future directions regarding coronary artery calcium (CAC) and risk of sudden cardiac death (SCD).
Recent Findings:
Although up to 80% of all SCD is attributed to coronary heart disease (CHD), the subclinical atherosclerosis markers that help to improve SCD risk prediction are largely unknown. Recent observational data have demonstrated that, after adjustment for traditional risk factors, there is a stepwise higher risk for SCD across increasing CAC burden such that asymptomatic patients without overt atherosclerotic cardiovascular disease (ASCVD) experience a three-fold to five-fold higher SCD risk beginning at CAC at least 100 when compared with CAC = 0. Although the mechanisms underlying increasing CAC and SCD risk have yet to be fully elucidated, risk for myocardial infarction and scar, and/or exercise-induced ischemia may be potential mediators.
Summary:
High CAC burden is an important risk factor for SCD in asymptomatic middle-aged adults, suggesting that SCD risk stratification can begin in the early stages of CHD via measurement of calcific plaque on noncontrast computed tomography. Despite the clinical inertia for downstream functional cardiac testing after detecting high CAC, comprehensive ASCVD prevention strategies should be the primary focus for SCD risk reduction.
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