Sathiyakumar Vasanth, Blumenthal Roger S, Nasir Khurram, Martin Seth S
Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, 600 N Wolfe St, Carnegie 591, Baltimore, MD, 21287, USA.
Center for Healthcare Advancement and Outcomes & Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA.
Curr Atheroscler Rep. 2017 Feb;19(2):7. doi: 10.1007/s11883-017-0643-4.
Coronary artery calcium (CAC) has been proposed as an integrator of information from traditionally measured, non-traditionally measured, and unmeasured risk factors for coronary atherosclerosis. The 2013 American College of Cardiology/American Heart Association Guideline on the Assessment of Cardiovascular Risk identified several knowledge gaps regarding CAC, including radiation risks, cost-effectiveness, and improving discrimination and reclassification of estimated risk over the Pooled Cohort Equations in the ACC/AHA Atherosclerotic Cardiovascular Disease Estimator. In this review, we focus on recent CAC literature addressing these knowledge gaps. We further highlight the potential for CAC to enrich future randomized controlled trials.
The use of CAC allows for personalization of cardiovascular risk despite the presence or absence of traditional risk factors across many demographics. Avenues to reduce radiation exposure associated with CAC scanning include increasing the interval between scans for those with CAC scores of zero and estimating CAC from non-cardiac gated CT scans. While limited studies have suggested cost-effectiveness in cardiac risk assessment with the incorporation of CAC in screening algorithms, several studies have demonstrated the ability of CAC to identify non-traditional risk factors that may be used to expand cardiovascular risk personalization in other high-risk populations. Literature from the past 2 years further supports CAC as a strong marker to personalize cardiac risk assessment. While multiple potential avenues to reduce radiation are available and cost-effectiveness analyses are encouraging, further studies are necessary to clarify patient selection for CAC scanning given the interplay between CAC and other imaging modalities in risk personalization algorithms.
冠状动脉钙化（CAC）被认为是整合来自传统测量、非传统测量以及未测量的冠状动脉粥样硬化危险因素信息的指标。2013年美国心脏病学会/美国心脏协会心血管风险评估指南确定了关于CAC的几个知识空白，包括辐射风险、成本效益以及在ACC/AHA动脉粥样硬化性心血管疾病评估器中，相较于合并队列方程，如何改善估计风险的辨别和重新分类。在本综述中，我们聚焦于近期解决这些知识空白的CAC文献。我们还进一步强调了CAC在丰富未来随机对照试验方面的潜力。
无论许多人群中是否存在传统危险因素，使用CAC都能实现心血管风险的个性化。减少与CAC扫描相关辐射暴露的途径包括：对于CAC评分为零的患者增加扫描间隔时间，以及从非心脏门控CT扫描中估算CAC。虽然有限的研究表明将CAC纳入筛查算法进行心脏风险评估具有成本效益，但多项研究已证明CAC能够识别非传统危险因素，这些因素可用于在其他高危人群中扩大心血管风险的个性化评估。过去两年的文献进一步支持CAC作为个性化心脏风险评估的有力标志物。虽然有多种减少辐射的潜在途径且成本效益分析结果令人鼓舞，但鉴于在风险个性化算法中CAC与其他成像方式之间的相互作用，仍需要进一步研究以明确CAC扫描的患者选择标准。
