Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, 21287, USA.
Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, 21287, USA.
Curr Atheroscler Rep. 2016 Mar;18(3):13. doi: 10.1007/s11883-016-0565-6.
Estimating cardiovascular disease (CVD) risk is necessary for determining the potential net benefit of primary prevention pharmacotherapy. Risk estimation relying exclusively on traditional CVD risk factors may misclassify risk, resulting in both undertreatment and overtreatment. Coronary artery calcium (CAC) scoring personalizes risk prediction through direct visualization of calcified coronary atherosclerotic plaques and provides improved accuracy for coronary heart disease (CHD) or CVD risk estimation. In this review, we discuss the most recent studies on CAC, which unlike historical studies, focus sharply on clinical application. We describe the MESA CHD risk calculator, a recently developed CAC-based 10-year CHD risk estimator, which can help guide preventive therapy allocation by better identifying both high- and low-risk individuals. In closing, we discuss calcium density, regional distribution of CAC, and extra-coronary calcification, which represent the future of CAC and CVD risk assessment research and may lead to further improvements in risk prediction.
估算心血管疾病（CVD）风险对于确定初级预防药物治疗的潜在净效益是必要的。仅依靠传统 CVD 风险因素进行风险估计可能会错误分类风险，导致治疗不足和过度治疗。冠状动脉钙（CAC）评分通过直接可视化钙化的冠状动脉粥样硬化斑块来个性化风险预测，并为冠心病（CHD）或 CVD 风险估计提供更高的准确性。在这篇综述中，我们讨论了 CAC 的最新研究，这些研究与历史研究不同，重点关注临床应用。我们描述了 MESA CHD 风险计算器，这是一种最近开发的基于 CAC 的 10 年 CHD 风险估计器，它可以通过更好地识别高风险和低风险个体来帮助指导预防性治疗的分配。最后，我们讨论了钙密度、CAC 的区域分布和冠状动脉外钙化，它们代表了 CAC 和 CVD 风险评估研究的未来，可能会进一步提高风险预测的准确性。
