ECHO ROUNDS Section Editor: Edmund Kenneth Kerut, M.D.
Coronary Risk Assessment and Arterial Age Calculation Using Coronary Artery Calcium Scoring and the Framingham Risk Score
Edmund Kenneth Kerut M.D.,
Edmund Kenneth Kerut M.D.
Heart Clinic of Louisiana, Marrero, Louisiana
Search for more papers by this authorEdmund Kenneth Kerut M.D.,
Edmund Kenneth Kerut M.D.
Heart Clinic of Louisiana, Marrero, Louisiana
Search for more papers by this authorEdmund Kenneth Kerut, M.D., Heart Clinic of Louisiana, 1111 Medical Center Blvd, Suite N613, Marrero, LA 70072. Fax: 504-349-6621; E-mail: [email protected]
Abstract
(Echocardiography 2011;28:686-693)
References
- 1 Thom T, Haase N, Rosamond W, et al: American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics—2006 update: A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2006; 113: e85–e151.
- 2 Assmann G, Cullen P, Schulte H. Simple scoring scheme for calculating the risk of acute coronary events based on the 10-year follow-up of the prospective cardiovascular Münster (PROCAM) study. Circulation 2002; 105: 310–315.
- 3 Conroy RM, Pyorala K, Fitzgerald AP, et al: Estimation of ten-year risk of fatal cardiovascular disease in Europe: The SCORE project. Eur Heart J 2003; 24: 987–1003.
- 4 Wilson PW, D’Agostino RB, Levy D, et al: Prediction of coronary heart disease using risk factor categories. Circulation 1998; 97: 1837–1847.
- 5 International Task Force for the Prevention of Coronary Heart Disease. http://www.chd-taskforce.com/Accessed January 8, 2011.
- 6 International Task Force for the Prevention of Coronary Heart Disease. http://www.chd-taskforce.com/ Accessed January 8, 2011.
- 7 Framingham Heart Study. Coronary heart disease (10-year risk). http://www.framinghamheartstudy.org/risk/coronary.html. Accessed January 8, 2011.
- 8 Grundy SM, Cleeman JI, Merz CN, et al: Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. Circulation 2004; 110: 227–239.
- 9 Lichtenstein AH, Appel LJ, Brands M. Diet and lifestyle recommendations revision 2006: A scientific statement from the American Heart Association Nutrition Committee. Circulation 2006; 114: 82–96.
- 10 Schmermund A, Mohlenkamp S, Erbel R. Coronary artery calcium and its relationship to coronary artery disease. Cardiol Clin 2003; 21: 521–534.
- 11 Elkeles RS, Dunlop A, Thompson GR, et al: Coronary Calcification and predicted risk of coronary heart disease in asymptomatic men with hypercholesterolemia. J Cardiovasc Risk 2002; 9: 349–353.
- 12 Vliegenthart R, Oudkerk M, Song B, et al: Coronary calcification detected by electron-beam computed tomography and myocardial infaction. The Rotterdam coronary calcification study. Eur Heart J 2002; 23: 1596–1603.
- 13 Wexler L, Brundage B, Crouse J, et al: Coronary artery calcification: pathophysiology, epidemiology, image methods and clinical implications. A scientific statement from the American Heart Association. Circulation 1996; 94: 1175–1192.
- 14 Frink RJ, Achor RWP, OWN AL, et al: Significance of calcification of the coronary arteries. Am J Cardiol 1970; 26: 241–247.
- 15 Rumberger JA, Schwartz RS, Simons DB, et al: Relation of coronary calcium determined by electron beam computed tomography and lumen narrowing determined by autopsy. Am J Cardiol 1994; 73: 1169–1173.
- 16 Rumberger JA, Simons DB, Fitzpatrick LA, et al: Coronary artery calcium areas by electron beam computed tomography and coronary atherosclerotic plaque area: A histopathologic correlative study. Circulation 1995; 92: 2157–2162.
- 17 Baumgart D, Schmermund A, Goerge G, et al: Comparison of electron beam computed tomography with intracoronary ultrasound and coronary angiography for detection of coronary atherosclerosis. J Am Coll Cardiol 1997; 30: 57–64.
- 18 Simons DB, Schwartz RS, Edwards WD, et al: Noninvasive definition of anatomic coronary disease by ultrafast computed tomographic scanning: A quantitative pathologic comparison study. J Am Coll Cardiol 1992; 20: 1118–1126.
- 19 Mautner GC, Mautner SL, Froelich J, et al: Coronary artery calcification: assessment with electron beam CT and histomorphometric correlation. Radiology 1994; 192: 619–623.
- 20 Budoff MJ, Georgiou D, Brody A, et al: Ultrafast computed tomography as a diagnostic modality in the detection of coronary artery disease—A multicenter study. Circulation 1996; 93: 898–904.
- 21
Guerci AD,
Spadaro LA,
Popma JJ, et al: Electron beam tomography of the coronary arteries: relationship of coronary calcium score to arteriographic findings in asymptomatic and symptomatic adults.
Am J Cardiol
1997; 70: 128–133.
10.1016/S0002-9149(96)00698-4 Google Scholar
- 22 Budoff MJ, Achenbach S, Blumenthal RS, et al: American Heart Association Committee on Cardiovascular Imaging and Intervention; American Heart Association Council on Cardiovascular Radiology and Intervention; American Heart Association Committee on Cardiac Imaging, Council on Clinical Cardiology. Assessment of coronary artery disease by cardiac computed tomography: A scientific statement. Circulation 2006; 114: 1761–1791.
- 23 O’Rourke RA, Brundage BH, Froelicher VF, et al: American College of Cardiology/American Heart Association Expert consensus document on electorn-beam computed tomography for the diagnosis and prognosis of coronary artery disease. J Am Coll Cardiol 2000; 36: 326–340.
- 24 Arad Y, Goodman KJ, Roth M, et al: Coronary calcification, coronary disease risk factors, C-reactive protein, and atherosclerostic cardiovascular disease events: The St. Francis heart study. J Am Coll Cardiol 2005; 46: 158–165.
- 25 Greenland P, LaBree L, Azen SP, et al: Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. JAMA 2004; 291: 210–215.
- 26 Kondos GT, Hoff JA, Sevrukov A, et al: Electron-beam tomography coronary artery calcium and cardiac events: A 37-month follow-up of 5635 initially asymptomatic low- to intermediate-risk adults. Circulation 2003; 107: 2571–2576.
- 27 Taylor AJ, Bindeman J, Feuerstein I, et al: Coronary calcium independently predicts incident premature coronary heart disease over measured cardiovascular risk factors: Mean Three-year outcomes in the Prospective Army Coronary Calcium (PACC) project. J Am Coll Cardiol 2005; 46: 806–814.
- 28 LaMonte MJ, FitzGerald SJ, Chruch TS, et al: Coronary artery calcium score and coronary heart disease events in a large cohort of asymptomatic men and women. Am J Epidemiol 2005; 162: 421–429.
- 29 Detrano R, Carr JJ, Burke J, et al: Coronary calcium predicts near-term coronary heart disease events in major American ethnic groups: The multi-ethnic study of atherosclerosis. J Am Coll Cardiol 2007; 49: 101A.
- 30 Agatston AS, Janowitz WR, Hildner FJ, et al: Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 1990; 15: 827–832.
- 31 Rumberger JA, Brundage BH, Rader DJ, et al: Electron beam computed tomographic coronary calcium scanning: A review and guidelines for use in asymptomatic persons. Mayo Clin Proc 1999; 74(3): 243–252.
- 32 Greenland P, Bonow RO, Brundage BH, et al: ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain: A report of the American College of Cardiology Foundation Clinical Expert Consensus Task Force (ACCF/AHA writing committee to update the 2000 expert consensus document on electron beam computed tomography). J Am Coll Cardiol 2007; 49: 378–402.
- 33 Shareghi S, Ahmadi N, Young E, et al: Prognostic significance of zero coronary calcium scores on cardiac computed tomography. J Cardiovasc Comp Tomography 2007; 1: 155–159.
- 34 Raggi P, Cooil B, Callister TQ: Use of electron beam tomography data to develop models for prediction of hard coronary events. Am Heart J 2001; 141: 375–382.
- 35 Gopal A, Budoff MJ: Coronary calcium scanning. Am Heart Hops J 2006: 4: 43–50.
- 35a. Park R, Detrano F, Xiang M, et al: Combined use of computed tomography coronary calcium scores and C-reactive protein levels in predicting cardiovascular event in nondiabetic individuals. Circulation 2002; 106: 2073–2077.
- 36 Vliegenthart R, Oudkerk M, Hofman A, et al: Coronary calcification improves cardiovascular risk prediction in the elderly. Circulation 2005; 112: 572–577.
- 37 Detrano R, Guerci AD, Carr JJ, et al: Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med 2008; 358: 1336–1345.
- 38 Budoff MJ, Nasir K, McClelland RL, et al: Coronary calcium predicts events better with absolute calcium scores than age-sex-race/ethnicity percentiles. J Am Coll Cardiol 2009; 53: 345–352.
- 39 Bonow RO: Should coronary calcium screening be used in cardiovascular prevention strategies? N Engl J Med 2009; 361: 990–997.
- 40 Wayhs R, Zelinger A, Raggi P: High coronary artery calcium scores pose an extremely elevated risk for hard events. J Am Coll Cardiol 2002; 39: 225–230.
- 41 Church TS, Levine BD, McGuire DK, et al: Coronary artery calcium score, risk factors, and incident coronary heart disease events. Atherosclerosis 2007; 190(1): 224–231.
- 42 Sarwar A, Shaw LJ, Shapiro MD, et al: Diagnostic and prognostic value of absence of coronary artery calcification. J Am Coll Cardiol Img 2009; 2: 675–688.
- 43 Budoff MJ, Shaw LJ, Liu ST, et al: Long-term prognosis associated with coronary calcification: Observations from a registry of 25,253 patients. J Am Coll Cardiol 2007; 49: 1860–1870.
- 44 Detrano A, Guerci AAD, Carr JJ, et al: Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med 2008; 358: 1336–1345.
- 45 Blaha M, Budoff MJ, Shaw LJ, et al: Absence of coronary artery calcification and all-cause mortality. J Am Coll Cardiol Img 2009; 2: 692–700.
- 46 Kronmal RA, McClelland RL, Detrano R, et al: Risk factors for the progression of coronary artery calcification in asymptomatic subjects: results from the multi-ethnic study of atherosclerosis (MESA). Circulation 2007; 115: 2722–2730.
- 47 Rubinshtein R, Gaspar T, Halon DA, et al: Prevalence and extent of obstructive coronary artery disease in patients with zero or low calcium score undergoing 64-slice cardiac multidetector computed tomography for evaluation of a chest pain syndrome. Am J Cardiol 2007; 99: 472–475.
- 48 Grundy SM, Benjamin IJ, Burke GL, et al: Diabetes and cardiovascular disease. A statement for healthcare professionals from the American Heart Association. Circulation 1999; 100: 1134–1146.
- 49 Prevalence of Asymptomatic Myocardial Ischaemia in Diabetic Subjects. BMJ 1990; 301: 92–95.
- 50 Haffner SM, Lehto S, Ronnemaa T, et al: Mortality from coronary heart disease in subjects with type 2 diabetes and in non-diabetic subjects with and without prior Myocardial infarction. N Engl J Med 1998; 339: 229–234.
- 51 Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA 2001; 285: 2486–2497.
- 52 Elkeles RS, Godsland IF, Feher MD, et al: Coronary calcium measurement improves prediction of cardiovascular events in asymptomatic patients with type 2 diabetes: The PREDICT study. Eur Heart J 2008; 29: 2244–2251.
- 53 Turner RC, Milns H, Neil HW, et al: United Kingdom prospective diabetes study group. Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus United Kingdom Prospective Diabetes Study (UKPDS 23). Br Med J 1998; 316: 823–828.
- 54 Raggi P, Shaw LJ, Berman DS, et al: Prognostic value of coronary artery calcium screening in subjects with and without diabetes. J Am Coll Cardiol 2004; 43: 1663–1669.
- 55 Budoff MJ. Not all diabetics are created equal (in cardiovascular risk). Eur Heart J 2008; 29: 2193–2194.
- 56 Narla V, Santos RD, Campbell CY, et al: Coronary artery calcification and inflammation according to various metabolic syndrome definitions. J Cardiometab Syndr 2009; 4: 33–39.
- 57 Ibebuogu UN, Ahmadi N, Hajsadeghi F: Measures of coronary artery calcification and association with the metabolic syndrome and diabetes. J Cardiometab Syndr 2009; 4: 6–11.
- 58 Schisterman E, Whitcomb BW: BMC medical imaging 2004; 4: 1–9.
- 59 Sirineni GKR, Raggi P, Shaw LJ, et al: Calculation of coronary age using calcium scores in multiple ethnicities. Int J Cardiovasc Imaging 2008; 24: 107–111.
- 60 Shaw LJ, Raggi P, Berman DS, et al: Coronary artery calcium as a measure of biologic age. Atherosclerosis 2006; 188: 112–119.
- 61 McClelland RL, Nasir K, Budoff M, et al: Arterial age as a function of coronary artery calcium (from the multi-ethnic study of atherosclerosis [MESA]). Am J Cardiol 2009; 103: 59–63.
- 62 Budoff MJ, Nasir K, McClelland RL, et al: Coronary calcium predicts events better with absolute calcium scores than age-sex-race/ethnicity percentiles. J Am Coll Cardiol 2009; 53: 345–352.
- 63 Schiele F, Meneveau N: Are you as old as your arteries or as old as your coronary artery calcification score? J Am Coll Cardiol 2009; 53: 353–354.
- 64 Lloyd-Jones DM, Leip EP, Larson MG, et al: Prediction of lifetime risk for cardiovascular disease by risk factor burden at 50 years of age. Circulation 2006; 113: 791–798.
- 65 Daviglus ML, Liu K, Pirzada A, et al: Favorable cardiovascular risk profile in middle age and health-related quality of life in older age. Arch Intern Med 2003; 163: 2460–2468.
- 66 Lakoski SG, Greenland P, Wong ND, et al: Coronary artery calcium scores and risk for cardiovascular events in women classified as low-risk by Framingham risk score. The multi-ethnic study of atherosclerosis (MESA). Arch Intern Med 2007; 167(22): 2437–2442.
- 67 National Cholesterol Education Program (NCEP) Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). Third report of the National Cholesterol Education Program (NCEP) expert panel on detection evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) final report. Circulation 2002; 106: 3143–3421.
- 68 McPherson R, Frohlich J, Fodor G, et al: Canadian cardiovascular society position statement: recommendations for the diagnosis and treatment of dyslipidemia and prevention of cardiovascular disease. Can J Cardiol 2006: 22: 913–927.
- 69 Mosca L, Banka CL, Benjamin EJ, et al: Evidence-based guidelines for cardiovascular disease prevention in women: 2007 update. Circulation 2007; 115: 1481–1501.
- 70 Berry JD, Liu K, Folsom AR, et al: Prevalence and progression of subclinical atherosclerosis in younger adults with low short-term but high lifetime estimated risk for cardiovascular disease: The coronary artery risk development in young adults study and multi-ethnic study of atherosclerosis. Circulation 2009; 119: 382–389.
- 71 Loria CM, Liu K, Lewis CE, et al: Early adult risk factor levels and subsequent coronary artery calcification: The CARDIA study. J Am Coll Cardiol 2007; 49: 2013–2020.
- 72 Nambi V, Ballantyne CM: “Risky business” ten years is not a lifetime. Circulation 2009; 119: 362–364.
- 73 Brenner DJ, Hall EJ: Computed tomography—An increasing source of radiation exposure. N Engl J Med 2007; 357(22): 2277–2284.
- 74 Gerber TC, Kantor B, McCollough CH: Radiation dose and safety in cardiac computed tomography. Cardiol Clin 2009; 27(4): 665–677.
- 75 Kim KP, Einstein AJ, Berrington de et al: Coronary artery calcification screening: estimated radiation dose and cancer risk. Arch Intern Med 2009; 169: 1188–1194.
- 76 U.S. Food and Drug Administration. What are the radiation risks from CT? http://www.fda.gov/Radiation-EmittingProducts/RadiationEmittingProductsandProcedures/MedicalImaging/MedicalX-Rays/ucm115329.htm. Accessed January 8, 2011.
- 77 Fazel R, Krumholz HM, Wang Y, et al: Exposure to low-dose ionizing radiation from medical imaging procedures. N Engl J Med 2009; 361: 849–857.
- 78 Lauer MS: Elements of danger—The case of medical imaging. N Engl J Med 2009; 361: 841–843.
- 79 Kerut EK, To F: Risk of low-level ionizing radiation from medical imaging procedures. Echocardiography, in press.
- 80 McCullough PA, Chinnaiyan KM: Annual progression of coronary calcification in trials of preventive therapies. Arch Intern Med 2009; 169(22): 2064–2070.
- 81 Callister TQ, Raggi P, Cooil B. Effects of HMG-CoA Reductase Inhibitors on Coronary Artery Disease. N Engl J Med 1998; 339: 1972–1977.
- 82 Budoff MJ, Lane KL, Bakhseshi H, et al: Rates of progression of coronary calcium by electron beam tomography. Am J Cardiol 2000; 86: 8–11.
- 83 Budoff MJ, Hokanson JE, Nasir K, et al: Progression of coronary artery calcium predicts all-cause mortality. J Am Coll Cardiol Img 2010; 3: 1229–1236.
- 84 Kronmal RA, McClelland RL, Detrano R, et al: Risk factors for the progression of coronary artery calcification in asymptomatic subjects—Results from the multi-ethnic study of atherosclerosis (MES). Circulation 2007; 29:115: 2722–2730.
- 85 Achenbach S, Ropers D, Pohle K, et al: Influence of lipid-lowering therapy on the progression of coronary artery calcification: A prospective evaluation. Circulation 2002; 106: 1077–1082.
- 86 Raggi P, Davidson M, Callister TQ, et al: Aggressive versus moderate lipid-lowering therapy in hypercholesterolemic post-menopausal women: beyond endorsed lipid lowering with EBT scanning (BELLES). Circulation 2005; 112(4): 563–571.
- 87 Arad Y, Spadaro LA, Roth M, et al: Treatment of asymptomatic adults with elevated coronary calcium scores with atorvastatin, Vitamin C, and Vitamin E: The St. Francis heart study randomized clinical trial. J Am Coll Cardiol 2005; 46(1): 166–172.
- 88 Schmermund A, Achenbach S, Dudde T, et al: Effect of intensive versus standard lipd-lowering treament with atorvastatin on the progression of calcified coronary atherosclerosis over 12 months: A multicenter, randomized, double-blind trial. Circulation 2006; 112(3): 427–437.
- 89 Houslay ES, Cowell SJ, Prescott RJ, et al: Scottish aortic stenosis and lipid lowering therapy, impact on regression trial investigators. progressive coronary calcification Despite intensive lipd-lowering treatment: A randomised controlled trial. Heart 2006; 92(9): 1207–1212.
- 90 Arad Y, Goodman KJ, Roth M, et al: Coronary calcification, coronary disease risk factors, c-reactive protein, and atherosclerotic cardiovascular disease events: The St. Francis heart study. J Am Coll Cardiol 2005; 46: 158–165.
- 91 Underhill HR, Yuan C, Zhao XQ, et al: Effect of Rosuvastatin therapy on carotid plaque morphology and composition in moderately hypercholesterolemic patients: A high-resolution magnetic resonance imaging trial. Am Heart J 2008; 155: e581-e588.
- 92 Nissen SE, Nicholls SJ, Sipahi I, et al: Effect of very high-intensity statin therapy on regression of coronary atherosclerosis: The ASTEROID trial. JAMA 2006; 295: 1556–1565.
- 93 Nicholls SJ. Rosuvastatin and progression of atherosclerosis: Expert Rev Cardiovasc Therapy 2008; 6(7): 925–933.
- 94 Moe SM, Chen NX. Pathophysiology of vascular calcification in chronic kidney disease. Circ Res 2004; 95: 560–567.
- 95 Braun J, Oldendorf M, Moshage W, et al: Electron beam computed tomography in the evaluation of cardiac calcification in chronic dialysis patients. Am J Kidney Dis 1996; 27: 394–401.
- 96 Goodman WG, Goldin J, Kuizon BD, et al: Coronary artery calcification in young adults with end-stage renal disease who are undergoing dialysis. N Engl J Med 2000; 342: 1478–1483.
- 97 Sarnak MJ, Levey AS, Schoolwerth AC, et al: Kidney disease as a risk factor for development of cardiovascular disease: A statement rom the american heart association councils on kidney in cardiovascular disease, high blood pressure research, clinical cardiology, and epidemiology and prevention. Circulation 2003; 108: 2154–2169.
- 98 Raggi P, Boulay A, Chasan-Taber S, et al: Cardiac calcification in adult hemodialysis patients. A link between end-state renal disease and cardiovascular disease? J Am Coll Cardiol 2002; 39: 695–701.
- 99 Matsuoka M, Iseki K, Tamashiro M, et al: Impact of high coronary artery calcification score (CACS) on survival in patients on chronic hemodialysis. Clin Exp Nephrol 2004; 8: 54–58.
- 100 Chertow GM, Burke SK, Raggi P: Sevelamer attenuates the progression of coronary and aortic calcification in hemodialysis patients. Kidney Int 2002; 62: 245–252.
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