CAC screening for cardiovascular disease development
The CAC screening is used to assess the risk of developing
cardiovascular diseases; however, it is not recommended for patients
with low risk of coronary heart disease or for patients who already had
an episode of heart attack, stroke, stent, or bypass surgery. Instead,
the 2013 American College of Cardiology/American Heart Association
(ACC/AHA) guidelines on screening for CAD deem measurement of CAC
reasonable for cardiovascular risk assessment in asymptomatic
intermediate-risk adults.14 It was found that amongst
the different current markers that are used to reclassify
intermediate-risk patients, CAC scoring proved most useful, which is
unsurprising given that it is a direct gauge of the dynamic pathological
process taking place in the coronary arteries.15
The use of relevant patient data, such as age, sex, and race, to inform
interpretation can further enhance the accuracy of CAC scoring, with
age- and sex-adjusted percentiles proving a more useful measure than
absolute calcium scoring.16 It is important to note
that, as with a number of other tests, the value of CAC may vary
depending on the ethnicity of the target population; for instance,
African Americans may have significantly less CAC than white Americans
despite a worse metabolic profile, therefore emphasizing the importance
of using ethnicity-specific data to guide the interpretation of CAC
scores. The Multi-Ethnic Study of Atherosclerosis (MESA) is a commonly
used population database that has been used to calculate adjusted
percentiles that can better assess patient risk.17–21