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ANGINA VIDEO: Calcium in Coronary Arteries Predicts Risk of Coronary Event (Interview with Dr. Philip Greenland, MD, Northwestern University)
ANGINA VIDEO: Calcium in Coronary Arteries Predicts Risk of Coronary Event (Interview with Dr. Philip Greenland, MD, Northwestern University)

(April 27, 2010 - Insidermedicine)

Taking coronary artery calcium score into account when calculating risk models for coronary heart disease improves predictive ability, according to research published in the April 28 issue of the Journal of the American Medical Association.

Here are some recommendations for measurement of coronary artery calcification (CAC) from the American College of Cardiology Foundation and the American Heart Association:

•    It may be reasonable to consider use of CAC measurement in such patients based on available evidence that demonstrates incremental risk prediction information in the intermediate risk patient group

•    This conclusion is based on the possibility that such patients might be reclassified to a higher risk status based on high CAC score, and subsequent patient management may be modified

•    In patients with a low or high coronary heart disease risk, use of CAC measurement is not recommended, as it is unlikely to affect clinical decision making

Researchers out of Northwestern University in Chicago measured the coronary artery calcium score of 6,814 participants in the Multi-Ethnic Study of Atherosclerosis (MESA). All participants had no known cardiovascular disease, and those with diabetes were excluded from the primary analysis. The investigators evaluated the participants’ five-year risk for the incidence of coronary heart disease using two models. The first model used age, sex, tobacco use, systolic blood pressure, antihypertensive medication use, total and HDL cholesterol, and race/ethnicity. The second model used all of these risk factors plus coronary artery calcium score.

A final cohort of 5,878 participants was followed-up for a median of 5.8 years, during which time 209 experienced a coronary heart disease event. Adding coronary artery calcium score to risk modeling improved predictions of coronary heart disease significantly. In fact, adding this factor resulted in an additional 23% of participants who actually experienced a coronary event being classified as high risk. It also resulted in an additional 13% of participants who did not experience an event being classified as low risk.

Today’s research suggests that it is clinically valuable to consider coronary calcium when assessing patients for risk of coronary events.

 
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