Coronary Calcium Screening and Role in Preventive Cardiology

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.

Dr. Nathan D Wong

Dr. Nathan Wong is a cardiovascular epidemiologist and Professor and Director, Heart Disease Prevention Program, Division of Cardiology at the University of California, Irvine in California. He holds MPH and PhD degrees in epidemiology from Yale University and is a fellow of the American College of Cardiology, American Heart Association, National Lipid Association, and American Society for Preventive Cardiology He is a past president of the American Society for Preventive Cardiology and Pacific Lipid Association (Chapter of the National Lipid Association), and president-elect of the Interamerican Heart Foundation. Dr. Wong has primary research interests in subclinical atherosclerosis, lipid and diabetes management, and cardiovascular disease epidemiology and prevention and has authored over 300 papers and co-edited six textbooks, including the Braunwald Companion on Preventive Cardiology and the ASPC Manual on Preventive Cardiology.

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