Coronary Calcium Score vs. Computed Tomography Angiography as Tools to Stratify Cardiovascular Risk
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NOVEL AND EMERGING RISK FACTORS (K. NASIR, SECTION EDITOR)
Coronary Calcium Score vs. Computed Tomography Angiography as Tools to Stratify Cardiovascular Risk Marcio S. Bittencourt 1,2
# Springer Science+Business Media, LLC, part of Springer Nature 2018
Abstract Purpose of Review This review evaluates the evidence for and against the use of coronary artery calcium (CAC) score and coronary computed tomography angiography (CTA) on the cardiovascular risk stratification for primary prevention in asymptomatic individuals. Recent Findings Recent evidence suggests that the presence and extent of CAC are robust predictors of events across various populations and variable baseline risk. On the other hand, the absence of CAC is associated with a good prognosis event in older individuals or in those with multiple risk factor or high clinical risk. While coronary CTA is also useful for risk stratification, its results did not provide incremental discrimination of individuals once the CAC is accounted for. Thus, current evidence does not support its use in asymptomatic individuals. Summary CAC is a powerful tool for additional cardiovascular risk stratification in individuals where the need for pharmacological therapy for risk reduction in primary prevention is uncertain, such as in individuals with intermediate risk. Since coronary CTA does not further improve risk stratification in this population, it is not currently recommended in asymptomatic individuals. Keywords Coronary artery calcium score . Coronary computed tomography angiography . Atherosclerosis . Primary prevention . Cardiovascular risk
Introduction There is considerable debate on the most appropriate approach to stratify the cardiovascular risk of asymptomatic individuals. Several different guidelines from societies across the world have different recommendations, though they all rely on essentially the same predictors, i.e., age, gender, and cardiovascular risk factors, though the calculators are not the same across guidelines [1, 2]. Those risk stratification tools are of This article is part of the Topical Collection on Novel and Emerging Risk Factors * Marcio S. Bittencourt [email protected] 1
Preventive Medicine Center Hospital Israelita Albert Einstein & School of Medicine, Faculdade Israelita de Ciência da Saúde Albert Einstein, São Paulo, Brazil
2
Center for Clinical and Epidemiological Research, University Hospital and São Paulo State Cancer Institute, University of São Paulo, AV. Lineu Prestes, 2565, Butantã, São Paulo CEP: 05508-000, Brazil
particular interest as they are the key element used to identify individuals to whom primary prevention strategies are recommended [3]. Among those recommendations, the prescription of lipid-lowering medications has usually gained most attention though more recently the use of such calculators has also been proposed as part of the approach to use aspirin in primary prevention as well as in the target blood pressure levels for individuals with hypertension [4, 5••]. The rationale for the incorpo
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