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Published on: September 22, 2023
Risk stratifying individuals with zero, minimal, and mild coronary artery calcium for cardiovascular disease by
Salman Ansari1, Leili Pourafkari2, April Kinninger2
1California University of Science and Medicine - School of Medicine, Colton, CA, USA.
Insights
Even a minimal coronary artery calcium (CAC) score of 1-10 indicates greater plaque burden and higher coronary vascular disease (CVD) risk than a zero CAC score. This finding supports using CAC categories 0, 1-10, and 11-100 for improved CVD risk assessment.
Area of Science:
- Cardiology
- Radiology
- Preventive Medicine
Background:
- Coronary artery calcium (CAC) scoring is expanding for cardiovascular disease (CVD) risk assessment.
- Existing CAC risk categories vary, prompting evaluation of specific score ranges.
- This study focuses on plaque burden in patients with CAC scores of 0, 1-10, and 11-100.
Purpose of the Study:
- To evaluate coronary plaque burden across different CAC score categories (0, 1-10, 11-100).
- To determine the optimal use of CAC scoring for refining CVD risk stratification.
- To compare plaque composition and volume in relation to CAC scores.
Main Methods:
- Prospective CCTA trial data with CAC scores ≤100 were analyzed.
- Quantitative coronary plaque analysis was performed.
- CAC was categorized into zero (0), minimal (1-10), and mild (11-100) groups.
- Plaque characteristics (e.g., non-calcified, calcified) were assessed using multivariable regression, adjusted for cardiovascular risk factors.
Main Results:
- 378 subjects (53% female, average age 53.9) were analyzed.
- 51% had zero CAC, 16% minimal CAC, and 33% mild CAC.
- Minimal CAC (1-10) and mild CAC (11-100) groups showed higher prevalence of traditional CVD risk factors.
- Compared to zero CAC, minimal CAC was associated with significantly higher fibrous plaque, total non-calcified plaque, and total plaque volume.
- Mild CAC demonstrated significantly higher volumes of all plaque types compared to minimal CAC.
Conclusions:
- Individuals with minimal CAC (1-10) exhibit greater noncalcified and total coronary plaque volume than those with zero CAC.
- The increased plaque burden in the minimal CAC group signifies a higher CVD risk.
- Utilizing CAC categories of 0, 1-10, and 11-100 provides a more precise risk stratification for coronary vascular disease.
Background And Aims:
Use of coronary artery calcium (CAC) continues to expand, and several different categories of risk have been developed. Some categorize CAC as <10, 11-100 and > 100, while others use CAC = 0,1-10, 11-100 and > 100 as categories. We sought to evaluate the plaque burden in patients with CAC 0, 1-10 and 11-100 to evaluate the best use of CAC scoring for risk assessment.
Methods:
Patients were recruited from existing prospective CCTA trials with CAC scores ≤100 and quantitative coronary plaque analysis (QAngio, Medis). CAC was categorized into three groups: zero (CAC = 0), minimal (CAC 1-10), and mild (CAC 11-100). Plaque levels (low attenuated, fibrous, fibro-fatty, dense calcified, total non-calcified) were assessed using multivariable linear regression adjusted for cardiovascular risk factors (age, ethnicity, BMI, gender, hypertension, dyslipidemia, diabetes mellitus, past smoking).
Results:
378 subjects were included, with an average age of 53.9 ± 10.7 years and 53 % female. Among them, 51 % had 0 CAC, 16 % had minimal CAC (scores 1-10), and 33 % had mild CAC (scores 11-100). The minimal and mild CAC groups were significantly older, with higher rates of diabetes, hypertension, and hyperlipidemia. Multivariable analysis found no significant difference in low attenuated, fibro-fatty, and dense calcified plaque levels between the minimal and zero CAC groups. However, minimal CAC subjects had significantly higher fibrous, total non-calcified, and total plaque volumes than zero CAC. All plaque types were significantly higher in the mild group when comparing mild CAC to minimal CAC.
Conclusion:
Individuals with minimal calcium scores (1-10) had greater noncalcified coronary plaque (NCAP) and total plaque volume than individuals with a calcium score of zero. The increased presence of NCAP and total plaque volume in the minimal CAC (1-10) is clinically significant and place those patients at higher coronary vascular disease (CVD) risk than individuals with absent CAC (CAC = zero). Therefore, the use of CAC = 0, 1-10 and 11-100 is prudent to better categorize CVD risk.
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