Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of morbidity and mortality worldwide, with coronary artery disease being the most common manifestation. Early detection and risk stratification of individuals at high risk for ASCVD events are crucial for implementing preventive measures and reducing the burden of this disease.
One promising approach for predicting future ASCVD events is the use of incidental detection of thoracic and coronary calcium on non-contrast chest CT scans. Coronary artery calcium (CAC) is a marker of subclinical atherosclerosis and has been shown to be a strong predictor of future cardiovascular events. The presence and extent of CAC can provide valuable information about an individual’s risk of developing ASCVD, even in the absence of traditional risk factors.
Several studies have demonstrated the utility of CAC scoring in predicting ASCVD events. A meta-analysis published in the Journal of the American College of Cardiology found that individuals with a high CAC score (≥300) had a significantly increased risk of coronary heart disease events compared to those with a low CAC score (0). Another study published in Circulation showed that CAC scoring improved risk prediction beyond traditional risk factors, such as age, gender, and cholesterol levels.
In addition to CAC scoring, the presence of thoracic aortic calcium (TAC) on chest CT scans has also been associated with an increased risk of ASCVD events. A study published in JACC: Cardiovascular Imaging found that TAC was independently associated with incident ASCVD events, even after adjusting for traditional risk factors.
The use of incidental detection of thoracic and coronary calcium for predicting ASCVD events has several advantages. First, it provides additional information beyond traditional risk factors, allowing for more accurate risk stratification. Second, it can identify individuals at high risk for ASCVD who may benefit from more aggressive preventive measures, such as statin therapy or lifestyle modifications. Finally, it is a non-invasive and cost-effective method that can easily be incorporated into routine clinical practice.
Despite its potential benefits, there are some limitations to the use of incidental detection of thoracic and coronary calcium for predicting ASCVD events. Not all individuals undergo chest CT scans, so this approach may not be applicable to everyone. In addition, there is variability in CAC scoring methods and interpretation, which can affect the accuracy of risk prediction.
In conclusion, the incidental detection of thoracic and coronary calcium on non-contrast chest CT scans holds promise as a tool for predicting future ASCVD events. By providing additional information beyond traditional risk factors, CAC and TAC scoring can help identify individuals at high risk for ASCVD who may benefit from early intervention. Further research is needed to validate these findings and optimize the use of incidental calcium detection in clinical practice.