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