Coronary artery calcium scoring for individualized cardiovascular risk estimation in important patient subpopulations after the 2019 AHA/ACC primary prevention guidelines

• Published in: Progress in cardiovascular diseases Vol. 62; no. 5; pp. 423 - 430
• Main Authors: Dzaye, Omar, Dudum, Ramzi, Reiter-Brennan, Cara, Kianoush, Sina, Tota-Maharaj, Rajesh, Cainzos-Achirica, Miguel, Blaha, Michael J.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2019
• Subjects: Age Factors; ASCVD; CAC; Clinical Decision-Making; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - drug therapy; Coronary Artery Disease - epidemiology; Diabetes; Dyslipidemias - diagnosis; Dyslipidemias - drug therapy; Dyslipidemias - epidemiology; Female; Gender; Humans; Male; Patient Selection; Practice Guidelines as Topic - standards; Predictive Value of Tests; Primary Prevention - standards; Prognosis; Risk Assessment; Risk Factors; Risk stratification; Risk-enhancing factors; Severity of Illness Index; Sex Factors; Vascular Calcification - diagnostic imaging; Vascular Calcification - drug therapy; Vascular Calcification - epidemiology; MESA; NRI; ASCVD; LDL-C; Risk-enhancing factors; DM; Gender; CHS; FHS; HDL-C; CCTA; ESC; CRIC; Risk assessment; Risk stratification; CKD; hs-CRP; BMI; CAC; CARDIA; RA; AHA/ACC; CVD; MetS; PCE; HIV; NCP; Diabetes; CHD
• ISSN: 0033-0620; 1532-8643; 1873-1740
• DOI: 10.1016/j.pcad.2019.10.007

The 2018 and 2019 American Heart Association and American College of Cardiology (AHA/ACC) guidelines for primary prevention of atherosclerotic cardiovascular disease (ASCVD) recommend consideration of so-called “risk-enhancing factors” in borderline to intermediate risk individuals. These include high-risk race/ethnicity (e.g. South Asian origin), chronic kidney disease, a family history of premature ASCVD, the metabolic syndrome, chronic inflammatory disorders (e.g. rheumatoid arthritis [RA], psoriasis, or chronic human immunodeficiency virus [HIV]), and conditions specific to women, among others. Studies suggest, however, that risk may be highly heterogeneous within these subgroups. The AHA/ACC guidelines also recommend consideration of coronary artery calcium (CAC) scoring for further risk assessment in borderline to intermediate risk individuals in whom management is uncertain. Although the combination of risk enhancing factors and CAC burden (together with Pooled Cohort estimates) may lead to more accurate ASCVD risk assessment, few publications have closely examined the interplay between risk enhancing factors and CAC scoring for personalized risk estimation. Our aim is to review the relevant literature in this area. Although further research is clearly needed, CAC assessment seems a highly valuable option to inform individualized ASCVD risk management in these important, often highly heterogeneous patient subgroups.