Pavlović Jelena, Bos Daniel, Ikram M Kamran, Ikram M Arfan, Kavousi Maryam, Leening Maarten J G
Department of Epidemiology, Erasmus MC-University Medical Center, Rotterdam, the Netherlands.
Department of Epidemiology, Erasmus MC-University Medical Center, Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC-University Medical Center, Rotterdam, the Netherlands; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Clinical Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
JACC Cardiovasc Imaging. 2025 Apr;18(4):465-475. doi: 10.1016/j.jcmg.2024.12.008. Epub 2025 Mar 5.
The 2018 ACC (American College of Cardiology)/AHA (American Heart Association) and 2021 ESC (European Society of Cardiology)/EAS (European Atherosclerosis Society) guidelines recommend coronary artery calcium (CAC) score for risk refinement in primary prevention of atherosclerotic cardiovascular disease (ASCVD).
This study sought to compare CAC utility as a risk-refining tool following the ACC/AHA guideline using pooled cohort equations (PCE) or PREVENT (Predicting Risk of cardiovascular disease EVENTs) equations and ESC/EAS guideline using SCORE2 (Systematic COronary Risk Evaluation 2).
A total of 1,903 statin-naive participants 55 to 75 years of age, free of ASCVD and diabetes, with low-density lipoprotein cholesterol <190 mg/dL from the prospective population-based Rotterdam Study were included. Per the guidelines, we determined proportions of CAC scan-eligible and reclassified men and women, ASCVD incidence rates, and numbers needed to treat for 10 years (NNT).
By the ACC/AHA (PCE), 18.3% of men and 11.9% of women, and by ACC/AHA (PREVENT), 13.4% of men and 3.4% of women were eligible for a CAC scan. By the ESC/EAS, 46.6% of men and 44.9% of women were CAC eligible. Proportions of uprisked and derisked individuals varied per guideline. Among ACC/AHA and ESC/EAS CAC-eligible individuals, incidence rates ranged from 9.3 to 23.8 per 1,000 person-years, and the estimated NNT to prevent 1 ASCVD event, based on high-intensity statin use, varied from 11 to 26.
The ACC/AHA and ESC/EAS guidelines differ in the selection and application of the CAC score for primary prevention of ASCVD. Guideline-directed application of CAC score in a middle-aged apparently healthy population improved risk stratification at an acceptable NNT for both guidelines.
2018年美国心脏病学会（ACC）/美国心脏协会（AHA）以及2021年欧洲心脏病学会（ESC）/欧洲动脉粥样硬化学会（EAS）指南推荐使用冠状动脉钙化（CAC）评分来优化动脉粥样硬化性心血管疾病（ASCVD）一级预防中的风险评估。
本研究旨在比较依据ACC/AHA指南使用汇总队列方程（PCE）或PREVENT（心血管疾病事件预测）方程以及依据ESC/EAS指南使用SCORE2（系统性冠状动脉风险评估2）时，CAC作为风险优化工具的效用。
纳入了来自基于人群的前瞻性鹿特丹研究的1903名年龄在55至75岁之间、未服用他汀类药物、无ASCVD和糖尿病且低密度脂蛋白胆固醇<190mg/dL的参与者。根据指南，我们确定了符合CAC扫描条件以及重新分类的男性和女性的比例、ASCVD发病率以及10年所需治疗人数（NNT）。
按照ACC/AHA（PCE），18.3%的男性和11.9%的女性符合CAC扫描条件；按照ACC/AHA（PREVENT），13.4%的男性和3.4%的女性符合条件。按照ESC/EAS，46.6%的男性和44.9%的女性符合CAC扫描条件。不同指南中风险升高和降低个体的比例各不相同。在符合ACC/AHA和ESC/EAS CAC扫描条件的个体中，发病率为每1000人年9.3至23.8例，基于高强度他汀类药物使用，预防1例ASCVD事件的估计NNT在11至26之间。
ACC/AHA和ESC/EAS指南在ASCVD一级预防中CAC评分的选择和应用方面存在差异。在中年貌似健康人群中按照指南应用CAC评分可改善风险分层，且对于两个指南而言NNT均在可接受范围内。
