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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Coronary artery calcification distribution and progression in over 70 000 asymptomatic individuals: implications for
Da-Eun Sung1, Mi-Yeon Lee2, Jong-Young Lee3
1Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Insights
Most asymptomatic adults have a zero coronary artery calcium (CAC) score, indicating low atherosclerosis. Significant CAC (>100) is rare, persisting in only 4% after 10 years, even in older individuals.
Area of Science:
- Cardiology
- Preventive Medicine
- Epidemiology
Background:
- Subclinical atherosclerosis, indicated by coronary artery calcium (CAC) scoring, is a key predictor of cardiovascular events.
- Understanding the progression of CAC in asymptomatic individuals is crucial for risk stratification and preventive strategies.
Purpose of the Study:
- To determine the prevalence and progression of coronary artery calcium (CAC) in a large cohort of asymptomatic adults.
- To evaluate the duration for which a CAC score of 0 persists over time in this population.
Main Methods:
- Retrospective analysis of 70,389 asymptomatic individuals aged over 30 years from Korea with at least two CAC score assessments between 2010 and 2022.
- Subgroup analyses based on follow-up intervals (entire cohort, >=4 assessments within 10 years, follow-up after 5 years).
- Assessment of age- and sex-specific CAC distributions, incidence of new CAC, and changes in CAC scores over 6-12 years for those with an initial score of 0.
Main Results:
- 84% of participants (mean age 40.5 years, 87% men) had a baseline CAC score of 0; 93% of women had a baseline CAC score of 0.
- Incident CAC developed in 16% of those with an initial score of 0 within 5-6 years, with only 1% exceeding a score of 100.
- After 10 years, only 4% of the cohort exceeded a CAC score of 100, indicating a low prevalence of significant calcification.
Conclusions:
- A baseline CAC score of 0 is common in asymptomatic adults, signifying minimal subclinical atherosclerosis.
- Significant coronary calcification (CAC > 100) develops slowly, with a low percentage of individuals exceeding this threshold even after a decade of follow-up.
Aims:
To assess the prevalence and progression of CAC in asymptomatic individuals and evaluate the duration for which a CAC score of 0 persists over time.
Methods And Results:
This retrospective cohort study included 70 389 asymptomatic individuals aged over 30 years from Korea, with at least two CAC score assessments (2010-22). Subgroups were defined based on follow-up intervals: the entire cohort, those with at least four assessments within 10 years, and those with follow-up after five years. Analyses focused on age- and sex-specific CAC distributions, incidence and timing of new CAC, and changes in CAC scores among those with an initial score of 0 over 6-12 years. Among participants (mean age 40.5 ± 6.6 years; 87% men), 84% had a baseline CAC score of 0, and 3% had scores > 100. Notably, 93% of women had a CAC score of 0, with the highest percentages observed in younger women. Incident CAC developed in 16% of participants with an initial score of 0 within five to six years, with just 1% exceeding score of 100. Extended follow-up data showed a consistently low prevalence of significant CAC scores, with only 4% exceeding scores > 100 after 10 years.
Conclusion:
In a large Korean cohort of over 70 000 asymptomatic adults, most had baseline CAC = 0, indicating low subclinical atherosclerosis. Significant calcification (CAC > 100) was rare within 5-6 years, with only 4% exceeding 100 by 10 years, even among older subgroups.
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