Objectives This study aimed at investigating the additional contribution of coronary artery calcium (CAC) score to SAFEHEART (Spanish Familial Hypercholesterolemia Cohort Study) risk equation (SAFEHEART-RE) for cardiovascular risk prediction in heterozygous familial hypercholesterolemia (HeFH). Background Common cardiovascular risk equations are imprecise for HeFH. Because of the high phenotype variability of HeFH, CAC score could help to better stratify the risk of atherosclerotic cardiovascular disease (ASCVD). Methods REFERCHOL (French Registry of Familial Hypercholesterolemia) and SAFEHEART are 2 ongoing national registries on HeFH. We analyzed data from primary prevention HeFH patients undergoing CAC quantification. We used probability-weighted Cox proportional hazards models to estimate HRs. Area under the receiver-operating characteristic curve (AUC) and net reclassification improvement (NRI) were used to compare the incremental contribution of CAC score when added to the SAFEHEART-RE for ASCVD prediction. ASCVD was defined as coronary heart disease, stroke or transient ischemic attack, peripheral artery disease, resuscitated sudden death, and cardiovascular death. Results We included 1,624 patients (mean age: 48.5 ± 12.8 years; men: 45.7%) from both registries. After a median follow-up of 2.7 years (interquartile range: 0.4-5.0), ASCVD occurred in 81 subjects. The presence of a CAC score of >100 was associated with an HR of 32.05 (95% CI: 10.08-101.94) of developing ASCVD as compared to a CAC score of 0. Receiving-operating curve analysis showed a good performance of CAC score alone in ASCVD prediction (AUC: 0.860 [95% CI: 0.853-0.869]). The addition of log(CAC + 1) to SAFEHEART-RE resulted in a significantly improved prediction of ASCVD (AUC: 0.884 [95% CI: 0.871-0.894] for SAFEHEART-RE + log(CAC + 1) vs AUC: 0.793 [95% CI: 0.779-0.818] for SAFEHEART-RE; P  Conclusions CAC score proved its use in improving cardiovascular risk stratification and ASCVD prediction in statin-treated HeFH.

The Added Value of Coronary Calcium Score in Predicting Cardiovascular Events in Familial Hypercholesterolemia.

Despite updated guidelines and technological developments that allow for an accurate diagnosis, many asymptomatic individuals have a high risk of developing CAD or cardiac events. The CAC score can estimate a correct risk level for these subjects, which is clinically significant for adequate management of risk factors and obtaining personalized preventive therapy. This systematic review aims to assess the prognostic value of CAC score in asymptomatic individuals. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, a systematic literature search was performed to identify original articles since 2010 that evaluated the prognostic value of CAC score in asymptomatic individuals. The quality of the included studies was assessed by the QUIPS tool. A total of 45 articles were selected. Many of these (25 studies) evaluated the prognostic value of CAC score in asymptomatic subjects. In comparison, others (20 studies) evaluated the association of CAC score with other clinical parameters and imaging modalities or the comparison with computed tomography coronary angiography (CTCA). Our findings showed that the CAC score provides valuable prognostic information for predicting CAD risk in asymptomatic individuals.

/pdf/prognostic-value-of-coronary-calcium-score-in-asymptomatic-2mpstsiv.pdf

Prognostic Value of Coronary Calcium Score in Asymptomatic Individuals: A Systematic Review

Purpose of review On the brink of the 30th anniversary of the Agatston score we summarize the epidemiological data that shaped the recommendations relevant to coronary artery calcium (CAC) included in the 2018/2019 US and European guidelines for the primary prevention of atherosclerotic cardiovascular disease (ASCVD). We also discuss the implications of novel CAC research conducted in asymptomatic populations within the past 2 years. Recent findings Based on a wealth of observational evidence, CAC has emerged as a mainstay in personalized risk assessment and is now endorsed as a class IIa tool in both US and European guidelines. In the past 2 years, data supporting the prognostic power of CAC has kept mounting, with longer term follow-up data now available. CAC has been evaluated in a variety of patient populations including individuals with severe hypercholesterolemia, diabetes mellitus and younger adults with family history of ASCVD, in all of whom it may be able to inform a more personalized management. Novel CAC scoring approaches are also discussed. Summary Despite a strong endorsement in recent guidelines, active research in the last 2 years has provided further insights on the potential utility of CAC in informing a more individualized preventive management in broader populations.

The evolving role of coronary artery calcium in preventive cardiology 30 years after the Agatston score.

The pharmacological management of diabetes is mostly based on its cardiovascular risk assessment. For this purpose, coronary artery calcium score (CACS) is proposed with a soft (class IIb) recommendation, as its prognostic implication requires further evidence in different subsets. Thus, we carried-out a systematic review and meta-analysis to address the prevalence of high CACS, its determinants and prognostic value in asymptomatic patients with diabetes, with a special focus on different sex and ethnic groups. We carried out a systematic review of the published literature in several databases between 01/2000 and 01/2021. Original studies were included if they presented data on the prevalence, determinants and prognosis of high CACS in patients with diabetes without known cardiovascular disease. Using random effects models, we calculated pooled odds ratios (OR) for CACS determinants and Relative Risk (RR) for CACS prognostic value on all-cause mortality and/or fatal and non-fatal CV events in different categories. We included 23 studies (n = 20,999 patients). Female sex and black ethnicity presented the lowest prevalence of CACS>0. Age, male sex, non-black ethnicity and diabetes duration were identified as risk factors for high CACS. Among the 10 studies (n = 110,396 person-years) with prognostic data, the pooled RR for the occurrence of all-cause death and/or cardiovascular events were 4.03 (95%CI: 3.04–5.34), 5.87 (95%CI: 4.32–7.99) and 9.04 (95%CI: 5.81–14.06) respectively for CACS>0 vs. CACS = 0, CACS≥100 vs. CACS<10 and CACS≥400 vs. CACS<10. For similar CACS, these RR were greater in women than in men. Our meta-analysis demonstrates that the increase in CACS is strongly associated with an increased risk for all-cause mortality and/or fatal and non-fatal CV events in asymptomatic patients with diabetes. 

Prevalence, determinants and prognostic value of high coronary artery calcium score in asymptomatic patients with diabetes: A systematic review and meta-analysis

Update on the omega-3 fatty acid trial landscape: A narrative review with implications for primary prevention.

Objectives We sought to evaluate the gender-specific predictive value of coronary artery calcium (CAC) score on all-cause mortality and cardiovascular disease (CVD) mortality in individuals with and without diabetes mellitus (DM). Background CAC score is a robust predictor of CVD and all-cause mortality during long-term follow-up in large cohorts in adults with DM. However, less is known about its sex-specific impact on all-cause mortality in DM. Methods We evaluated 25,563 asymptomatic participants with no known history of coronary artery disease (CAD) who underwent clinically indicated CAC. 1999 (7.8%) individuals had diabetes. CAC was characterized as an Agatston score of 0, 1–99, 100–300, and ≫300. We evaluated the association between CAC and all-cause mortality and CVD mortality. Results Overall, 1345 individuals died (5.3%) from all causes during a mean follow-up of 14.7 ± 3.8 years. CAC score was 0 in 57.5% females and 34.4% of males without DM, while 36.6% females and 20.3% males with DM had CAC-0. The frequency of CAC ≫ 300 was 18% and 36% in females and males with DM, respectively. CAC score of zero was associated with low all-cause mortality event rate in females and males with diabetes (1.7 and 2.5 events per 1000 person-years, respectively). Cardiovascular mortality per 1000 person years was ≪1 in females and males with CAC score of 0 irrespective of their diabetes. Adjusted multivariable analysis, compared to CAC-0, HR for all-cause mortality associated with CAC 1–99, 100–299 and ≫300 were 1.74(95% CI 0.65, 4.63, P-0.20), 5.54(95% CI 2.16, 14.22, P ≪ 0.001) and 5.75(95% CI 2.30, 14.37, P ≪ 0.001) in females with DM respectively; in males with DM HR associated with CAC 1–99, 100–299 and ≫300 were 1.87(95% CI 0.95, 3.66, P-0.06), 2.15(95% CI 1.05, 4.38, P-0.035) and 2.60(95% CI 1.34, 5.0, P-0.004), respectively. Conclusion Presence of subclinical atherosclerosis varies among individuals with DM. The absence of CAC was associated with very low cardiovascular as well as all-cause mortality events in all subgroups during long term follow-up.

Low short-term and long-term cardiovascular and all-cause mortality in absence of coronary artery calcium: A 22-year follow-up observational study from large cohort

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Low short-term and long-term cardiovascular and all-cause mortality in absence of coronary artery calcium: A 22-year follow-up observational study from large cohort