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Updated: Jun 14, 2025
Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Coronary Artery Calcium Density and Risk of Cardiovascular Events: A Systematic Review and Meta-Analysis
Yuanqi Yong1, Julian Giovannucci1, Sow Neng Pang1
1Monash Health, Clayton, Victoria, Australia.
Insights
Higher coronary artery calcium (CAC) density indicates lower cardiovascular disease risk. This finding suggests CAC density can improve risk assessment and prevention strategies for asymptomatic individuals.
Area of Science:
- Cardiology
- Radiology
- Preventive Medicine
Background:
- Coronary artery calcium (CAC) density is increasingly recognized for its inverse association with plaque vulnerability and atherosclerotic cardiovascular disease (ASCVD) risk.
- Understanding the predictive value of CAC density is crucial for refining cardiovascular risk assessment.
Purpose of the Study:
- To systematically review and meta-analyze the predictive value of CAC density for future cardiovascular events.
- To assess the role of CAC density in asymptomatic individuals undergoing noncontrast CAC scoring computed tomography.
Main Methods:
- A systematic search of electronic databases identified studies reporting CAC density and subsequent cardiovascular disease (CVD) or coronary heart disease (CHD) events.
- Random-effects models were used to calculate pooled hazard ratios (HRs) and 95% confidence intervals (CIs).
- Subgroup analyses stratified by event type (CVD vs. CHD) and statin use were performed.
Main Results:
- Five studies with six cohorts, totaling 21,346 participants, met the inclusion criteria.
- Higher CAC density was significantly associated with a lower risk of cardiovascular events (HR: 0.80 per SD; P < 0.01) after adjusting for clinical risk factors and CAC volume.
- The protective association was observed in both CVD and CHD events and persisted in statin-naive patients, though not significantly in statin-treated patients.
Conclusions:
- Elevated CAC density is linked to reduced cardiovascular event risk when accounting for established risk factors and CAC volume.
- CAC density holds potential for enhancing CAC scoring and improving cardiovascular disease risk assessment, treatment, and prevention strategies.
Background:
There is increasing evidence that coronary artery calcium (CAC) density is inversely associated with plaque vulnerability and atherosclerotic cardiovascular disease risk.
Objectives:
A systematic review and meta-analysis were performed to examine the predictive value of CAC density for future cardiovascular events in asymptomatic individuals undergoing noncontrast CAC scoring computed tomography.
Methods:
Electronic databases were searched for studies reporting CAC density and subsequent cardiovascular disease (CVD) or coronary heart disease (CHD) events. Two independent reviewers performed data extraction. Random-effects models were used to estimate pooled HRs and 95% CIs. Subgroup analyses were performed with studies stratified by CVD vs CHD events and by statin use.
Results:
Of 5,029 citations, 5 studies with 6 cohorts met inclusion criteria. In total, 1,309 (6.1%) cardiovascular events occurred in 21,346 participants with median follow-up ranging from 5.2 to 16.7 years. Higher CAC density was inversely associated with risk of cardiovascular events following adjustment for clinical risk factors and CAC volume (HR: 0.80 per SD of density [95% CI: 0.72-0.89]; P < 0.01; I2 = 0%). There was no significant difference in the pooled HRs for CVD vs CHD events (HR: 0.80 per SD [95% CI: 0.71-0.90] vs 0.74 per SD [95% CI: 0.59-0.94] respectively; P = 0.59). The protective association between CAC density and event risk persisted among statin-naive patients (HR: 0.79 per SD [95% CI: 0.70-0.89]; P < 0.01) but not statin-treated patients (HR: 0.97 per SD [95% CI: 0.77-1.22]; P = 0.78); the test for interaction indicated no significant between-group differences (P = 0.12).
Conclusions:
Higher CAC density is associated with a lower risk of cardiovascular events when adjusted for risk factors and CAC volume. Future work may expand the contribution of CAC density in CAC scoring, and enhance its role in CVD risk assessment, treatment, and prevention.
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