Coronary Calcium Screening and Role in Preventive Cardiology

• Preventive cardiology efforts begin with the assessment of CVD risk.

• Risk assessment algorithms include the European SCORE, PROCAM, QRISK, FRAMINGHAM and the US Pooled Cohort Risk Equation (PCE).

• Despite many available risk assessment approaches, a substantial gap remains in detecting asymptomatic individuals who ultimately develop CHD.

• Criteria required for a good screening test

• Provides an accurate determination of the likelihood that an asymptomatic person has the condition (accuracy).

• Reproducible results (reliability).

• Detect individuals where early intervention is likely to have a beneficial impact.

• Should provide incremental value to risk predicted by office-based risk assessment.

• Coronary calcium invariably indicates the presence of atherosclerosis, but atherosclerotic lesions do not always contain calcium.

• Calcium deposition may occur early in life, as early as the second decade, and in lesions that are not advanced. The extent of CAC roughly correlates with the amount of overall atherosclerotic plaque, but there is great variability around the relationship.

• Suggested young adult groups for screening:

• Those with suspected or diagnosed familial hypercholesterolemia

• Those with a family history of premature ASCVD

• Those with multiple risk factors

• Those aged 40 to 45 are classified as a borderline-intermediate risk by the pooled cohort equation.

• Role for a complementary approach predicting ASCVD risk

• Global risk assessment with family history and other measures.

• Biomarkers (ideally predicting near-term risk).

• Subclinical disease imaging for atherosclerotic burden.