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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Coronary artery calcium scoring for cardiovascular risk assessment in patients with inflammatory bowel disease
Robert Naami1, Nour Tashtish2, Ian J Neeland2
1Department of Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH.
Insights
Coronary artery calcium (CAC) scoring identifies prevalent subclinical atherosclerosis in inflammatory bowel disease (IBD) patients, predicting cardiovascular events. This highlights the need for further research into IBD
Area of Science:
- Cardiology
- Gastroenterology
- Public Health
Background:
- Inflammatory bowel disease (IBD) is linked to an increased incidence of atherosclerotic cardiovascular disease (ASCVD).
- Limited data exists on the utility of coronary artery calcium (CAC) scoring for detecting subclinical atherosclerosis in IBD patients.
Approach:
- Utilized data from the CLARIFY registry, analyzing CAC scores in ulcerative colitis (UC) and Crohn's disease (CD) patients from 2014-2020.
- Assessed concordance between CAC risk and 10-year estimated ASCVD risk using established thresholds for statin prescription.
- Investigated the association of CAC scores with preventive therapy initiation and Major Adverse Cardiovascular Events (MACE).
Key Points:
- Among 369 IBD patients, CAC scoring revealed prevalent subclinical atherosclerosis, with no significant difference between UC and CD.
- CAC score, unlike pooled cohort equation ASCVD risk, predicted MACE, with a CAC score cutoff of 76 associated with a 4-fold increase in MACE.
- Approximately 52% of IBD patients had a 10-year estimated ASCVD risk of 7.5% or higher, with significant discordance between CAC and ASCVD risk.
Conclusions:
- Coronary artery calcium scoring is valuable for identifying subclinical atherosclerosis in IBD patients, which is associated with cardiovascular events.
- Further research is warranted to elucidate the biological mechanisms underlying the elevated atherosclerotic disease risk observed in adults with IBD.
Background:
Inflammatory bowel disease (IBD) is associated with higher incidence of atherosclerotic cardiovascular disease (ASCVD). Data investigating the role of coronary artery calcium (CAC) scoring in identifying subclinical atherosclerotic disease in IBD patients is scarce.
Methods:
Using data obtained from the CLARIFY registry, a prospective study of no-charge coronary artery calcium (CAC) testing at University Hospitals, we reviewed patients with ulcerative colitis (UC) or Crohn's disease (CD) who underwent CAC scoring from 2014 to 2020. We investigated the concordance between CAC risk and 10-year estimated ASCVD risk by AHA/ACC pooled cohort equation using pre-established thresholds for statin prescription (CAC≥100, 10-year ASCVD risk ≥7.5%). We additionally investigated the association between CAC, preventive therapy initiation and Major Adverse Cardiovascular Events (MACE).
Results:
A total of 369 patients with IBD were included (174 UC, 195 CD), with median age of 60 years. The median CAC score was 14.9 with no significant difference between UC and CD (P = .76). Overall, 151 (41%) had CAC of 0, 108 (29%) had CAC 1-99, 61 (17%) had CAC 100 to 399, and 49 (13%) had CAC ≥400 with no difference in CAC distribution between CD and UC (P = .17). There was no difference in median CAC between IBD or age/sex-matched controls (P = .34). Approximately half of the patients (52%) with IBD had 10-year estimated ASCVD risk of 7.5% or higher. Among patients with ASCVD risk <7.5% (n = 163), 29 (18%) had CAC≥100 and among patients with ASCVD risk ≥7.5% (n = 178), 102 (57%) had CAC <100. There was no difference between CAC<100 vs CAC≥100 with respect to CRP, use of immunosuppressive or amino-salicylate therapy, IBD severity or complications. CAC score (AUROC 0.67 [0.56-0.78]), but not PCE ASCVD risk (AUROC 0.60 [0.48-0.73]), was predictive of MACE. The best cut-off for CAC score was 76 (sensitivity = 60%, specificity = 69%), and was associated with 4-fold increase in MACE (Hazard Ratio 4.0 [2.0-8.1], P < .001).
Conclusion:
Subclinical atherosclerosis, as evaluated by CAC scoring, is prevalent in patients with IBD, and is associated with cardiovascular events. Further studies are needed to understand underlying biological processes of increased atherosclerotic disease risk among adults with IBD.
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