The Present and Future
JACC State-of-the-Art Review
Coronary Calcium Score and Cardiovascular Risk

https://doi.org/10.1016/j.jacc.2018.05.027Get rights and content
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Abstract

Coronary artery calcium (CAC) is a highly specific feature of coronary atherosclerosis. On the basis of single-center and multicenter clinical and population-based studies with short-term and long-term outcomes data (up to 15-year follow-up), CAC scoring has emerged as a widely available, consistent, and reproducible means of assessing risk for major cardiovascular outcomes, especially useful in asymptomatic people for planning primary prevention interventions such as statins and aspirin. CAC testing in asymptomatic populations is cost effective across a broad range of baseline risk. This review summarizes evidence concerning CAC, including its pathobiology, modalities for detection, predictive role, use in prediction scoring algorithms, CAC progression, evidence that CAC changes the clinical approach to the patient and patient behavior, novel applications of CAC, future directions in scoring CAC scans, and new CAC guidelines.

Key Words

aspirin
atherosclerotic cardiovascular disease
coronary artery calcification
coronary heart disease
statins

Abbreviations and Acronyms

ACC
American College of Cardiology
AHA
American Heart Association
ASCVD
atherosclerotic cardiovascular disease
CAC
coronary artery calcium
CAD
coronary artery disease
CHD
coronary heart disease
CT
computed tomography
EBCT
electron-beam computed tomography
MDCT
multidetector computed tomography
SCCT
Society of Cardiovascular Computed Tomography

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The Heinz Nixdorf Recall Study was funded by the Heinz Nixdorf Foundation, the German Aero-Space Center (Deutsches Zentrum für Luft- und Raumfahrt), and the German Research Council Assessment. The MESA study was supported by contracts HHSN268201500003I, N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168, and N01-HC-95169 from the National Heart, Lung, and Blood Institute and by grants UL1-TR-000040, UL1-TR-001079, and UL1-TR-001420 from the National Center for Advancing Translational Sciences. Dr. Blaha has received grant funding from the Aetna Foundation and the Amgen Foundation. Dr. Budoff has received funding from the National Institutes of Health and GE. Dr. Blaha is a member of the advisory boards of MedImmune, Akcea, Novartis, Amgen, Sanofi, and Regeneron. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Listen to this manuscript's audio summary by JACC Editor-in-Chief Dr. Valentin Fuster.