Al Rifai Mahmoud, Cainzos-Achirica Miguel, Kianoush Sina, Mirbolouk Mohammadhassan, Peng Allison, Comin-Colet Josep, Blaha Michael J
Department of Internal Medicine, The University of Kansas School of Medicine, Wichita, KS, USA.
Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Blalock 524D1, 600 N Wolfe St, Baltimore, MD, 21287, USA.
Curr Treat Options Cardiovasc Med. 2018 Sep 26;20(11):89. doi: 10.1007/s11936-018-0685-0.
In this review, we evaluate the coronary artery calcium (CAC) score as a biomarker for advanced atherosclerotic cardiovascular disease (ASCVD) risk assessment.
We summarize the evidence from multiple epidemiological studies, which show a clear advantage of CAC compared to traditional and non-traditional cardiovascular risk factors. We then compare the recommendations included in the 2013 American College of Cardiology/American Heart Association (ACC/AHA) and in the 2017 Society of Cardiovascular Computed Tomography (SCCT) guidelines for the use of CAC in ASCVD risk assessment, and examine the recent 2018 US Preventive Services Task Force (USPSTF) document. Finally, based on the currently available evidence, we provide constructive input for the upcoming ACC/AHA guidelines, regarding the population in whom CAC is most likely to be informative, the level of evidence that we believe should be assigned to CAC as an advanced ASCVD risk assessment tool, and the special populations in whom CAC might be beneficial for further risk assessment. We support a pragmatic approach that combines the pooled cohort equations (PCE) for initial ASCVD risk stratification, followed by CAC for refining ASCVD risk assessment among a broad range of intermediate risk patients and other special groups.
在本综述中，我们评估冠状动脉钙化（CAC）评分作为晚期动脉粥样硬化性心血管疾病（ASCVD）风险评估生物标志物的情况。
我们总结了多项流行病学研究的证据，这些证据表明，与传统和非传统心血管危险因素相比，CAC具有明显优势。然后，我们比较了2013年美国心脏病学会/美国心脏协会（ACC/AHA）和2017年心血管计算机断层扫描学会（SCCT）指南中关于在ASCVD风险评估中使用CAC的建议，并审视了2018年美国预防服务工作组（USPSTF）的最新文件。最后，基于目前可得的证据，我们为即将出台的ACC/AHA指南提供建设性意见，内容涉及最可能从CAC中获得信息的人群、我们认为应赋予CAC作为晚期ASCVD风险评估工具的证据水平，以及CAC可能有助于进一步风险评估的特殊人群。我们支持一种务实的方法，即先用汇总队列方程（PCE）进行初始ASCVD风险分层，然后用CAC在广泛的中度风险患者和其他特殊群体中完善ASCVD风险评估。
