. https://orcid.org CAC Coronary artery calcium. 1995, 70: 223-32. There was no evidence that the effects of age were non-linear (i.e. 2002, 90: 71i-6i. Combining information from the coronary artery calcium score with information from conventional risk factors to estimate coronary heart disease risk, http://www.biomedcentral.com/1741-7015/2/31/prepub. Male sex was a very strong predictor of the presence and extent of CAC women with the same CHD risk factor profile would be expected to develop CAC approximately 12 years later than men, and remain approximately 11 years behind men in the extent of their calcification. The amount of. PubMedGoogle Scholar. The CAC score has become an important tool for helping both the patient and physician decision regarding treatment and intensity. Robyn
MESA is a prospective cohort study designed to investigate subclinical cardiovascular disease in a multiethnic cohort free of clinical cardiovascular disease. These probabilities ranged widely based on the value of the 10-year risk estimate, with the probability of measuring a zero CAC score going from 75% (at a 10-year risk of 2.5%) to 13% (at a 10-year risk of 25%) (Table 4). Among 9341 asymptomatic study participants (age 3588 years, 40% female), we found that conventional coronary heart disease risk factors including age, male sex, self-reported hypertension, diabetes and high cholesterol were independent predictors of the CAC score, and we used the resulting multivariable models for predicting post-test risk in a variety of scenarios. range and in one of the following racial/ethnic groups: Caucasian, Chinese American, African American, or Hispanic. Your calcium score will be provided in terms of both an absolute score and percentile based upon age, gender, and ethnicity. Javaid A, Dardari ZA, Mitchell JD, Whelton SP, Dzaye O, Lima JAC, Lloyd-Jones DM, Budoff M, Nasir K, Berman DS, Rumberger J, Miedema MD, Villines TC, Blaha MJ. Hayden M, Pignone M, Phillips C, Mulrow C: Aspirin for the primary prevention of cardiovascular events: A summary of the evidence for the U.S. Preventive Services Task Force. JACC Asia. PMC / Pereira, Alexandre C.; Gomez, Luz M.; Bittencourt, Marcio Sommer et al. eCollection 2021 Jun. J Am Coll Cardiol. There were 6110 included in the analysis, with 53% female and an average age of 62 years. 1993, 72: 247-54. 10.1016/S0002-9149(02)02636-X. We then developed a method for combining information from conventional risk factors and the CAC score (easy spreadsheet calculator attached), and we present several examples illustrating how that method may be applied in common clinical situations. The current tool is thus applicable
Arch Intern Med. The CAC score was calculated according to the method described by Agatston [17]. Using US-derived percentiles in Brazilian individuals may lead to overestimating relative CAC burden in men and underestimating relative CAC burden in women. Europe PMC is an archive of life sciences journal literature. PubMed Percentiles by Race Women, n Men, n; Age, y Age, y; 45-54 55-64 65-74 75-84 45-54 55-64 65-74 75-84; White, n . Ann Intern Med. JAMA. Manage cookies/Do not sell my data we use in the preference centre. We also estimated these probabilities, using models with all CHD risk factor predictors, for the specific clinical scenario described in the Introduction (a 60-year-old woman with hypertension and high cholesterol) and for several other scenarios. CAC score in each coronary artery was equal to the sum of all lesions for that artery and the total CAC score was equal to the sum of the score of each artery. In these cases, and others in which the risk factor profile indicates very low or very high pre-test risk, the test is not likely to provide useful results, and the clinician might decide not to order the test. Distributions and burden of coronary calcium in asymptomatic Saudi patients referred to computed tomography. of heart attack in first degree relative (parent/sibling/child) (yes/no),
Five previous studies examined how CAC relates to conventional CHD risk factors [1115]. We also present expected CAC score distributions for a variety of clinical situations, which are not easily calculated from other studies, via Tables 4 and 5 and the attached spreadsheet calculator. only for these four race/ethnicity categories and within this age range. The 80-year-old man with high cholesterol has a high pre-test 10-year CHD risk (26%) and a high probability of having a high CAC score (70% will have a score > 100), in which case his post-test 10-year CHD risk would remain over 20% and his management would have to remain aggressive. 2021 Jun 15;1(1):93-102. doi: 10.1016/j.jacasi.2021.05.002. https://doi.org/10.1186/1741-7015-2-31, DOI: https://doi.org/10.1186/1741-7015-2-31. Abbreviations: CAC, coronary artery calcium. Rumberger JA, Brundage BH, Rader DJ, Kondos G: Electron beam computed tomographic coronary calcium scanning: a review and guidelines for use in asymptomatic persons. . Arterial age is then the
Similar to previous studies, individuals with self-reported coronary or cerebrovascular disease and those treated for diabetes mellitus were excluded from analysis. volume2, Articlenumber:31 (2004) The central problem with this approach is the fundamentally non-normal distribution of CAC scores, which makes parametric statistic testing (including both simple t-tests and multivariable linear regression) invalid. JACC Asia. Circulation. 2003, 349: 465-73. There were significant differences in calcium by race, and these associations differed across age and gender. McClelland RL, Chung H, Detrano R, Post W, Kronmal RA. Last medically reviewed on October 21, 2021. Smoking and diabetes mellitus were dichotomous variables in both Framingham models [16] and our data set. Do you know what disease caused the most deaths worldwide? /. The .gov means its official. Disclaimer, National Library of Medicine Comparison between actual and predicted CAC score distributions among a subset of the study population using three different modeling strategies. Results: Percentiles of CAC distribution were estimated with nonparametric techniques. Although the population distribution of CAC has been determined for several White populations, the distribution in ethnically admixed groups has not been well established. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Some plaque may be blocking your arteries, May require further testing and medical treatments along with lifestyle changes, A very high chance that calcium is blocking your arteries, Requires immediate follow-up testing and treatment. and Bensenor, {Isabela M.} and Lotufo, {Paulo A.}". All conventional CHD risk factors remained statistically significant predictors of the extent of coronary artery calcification (p < 0.001 for all predictors except high cholesterol at p = 0.004). The one-stage regression model using Ln(CAC score +1) as the outcome, which has been utilized extensively in previous research [11, 12, 14, 20], performed particularly poorly. 10.1016/0002-9149(93)90668-3. The https:// ensures that you are connecting to the This helps your doctor figure out an appropriate treatment plan to lower your chances of having one. Schaefer S: Will helical CT replace electron beam CT in the assessment of coronary calcium?. Several large cross-sectional studies have described the prevalence and extent of CAC among different age/sex groups [6, 810] without accounting for conventional CHD risk factors that may strongly influence predicted CAC scores. Using this methodology, we assessed the independent effects of CHD risk factors on both the presence and extent of CAC. While others have proposed similar Bayesian approaches to use of the CAC score for coronary risk prediction [6, 2124], ours has advantages. We compared the actual distribution of CAC scores among 5862-year-old women with hypertension and high cholesterol in our sample (n = 130) with predictions from 1) our two-stage model, 2) a one-stage model using Ln(CAC score + 1) as a continuous outcome in a linear regression model, and 3) a one-stage model using a censored normal distribution of cube-root transformed CAC scores (a Tobit regression model). Age, Gender, and Race-Based Coronary Artery Calcium Score Percentiles in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). However, even after square- and cube-root transformations, the zero scores were distributed in a manner inconsistent with the Tobit regression model. Please enable it to take advantage of the complete set of features! In our sample of the Brazilian population, we observed significant differences in CAC by sex, age, and race. Open Heart. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). doi: 10.1161/CIRCIMAGING.118.008104. Mayo Clin Proc. Bethesda, MD 20894, Web Policies Actual prevalence measurements were from the 58- to 62-year-old non-smoking women in our study sample with hypertension, high cholesterol level, and no diabetes (n = 127). Hypothesis: The CAC distribution, stratified for age, gender and race, is similar to the previously described distribution in the MESA study. Hypothesis: The CAC distribution, stratified for age, gender and race, is similar to the previously described distribution in the MESA study. The Tobit model uses the cube-root of the CAC score as a continuous outcome for linear regression analysis, but assumes that scores at or below zero have been censored (coefficients not presented). The gender-specific 99th percentile was also characteristic of some moderately sensitive . Results: Our models should be applied to other similar cohorts for validation, and also applied in cohorts that include different racial/ethnic groups and different ways of measuring the CAC score before being used in these clinical situations. By continuing you agree to the use of cookies. values are based on participants in the MESA study who were free of clinical
You can learn more about how we ensure our content is accurate and current by reading our. ", or if their physician confirmed that such a condition was documented in their medical records. In this article, we present a clinically useful method of combining information from the CAC score with pre-test coronary risk estimates. Sung NS, Crowley WF, Genel Mea: Central challenges facing the national clinical research enterprise. J Am Coll Cardiol. Similar to previous studies, individuals with self-reported coronary or cerebrovascular disease and those treated for diabetes mellitus were excluded from analysis. Breen JF, Schwartz RS. The higher your score in this measurement, the more severe your risk is for a heart attack. Coronary Artery Calcium Progression Among the US and Japanese Men. 2023 American College of Cardiology Foundation. The "two-stage model predictions" use the coefficients presented in Tables 2 and 3 (the full model). By integrating this information with previously published relative risk estimates (see Additional File 1), we estimate her 10-year CHD risk to be as low as 6% (if her CAC score is 0), or as high as 51% (if her CAC score is >400). CAC Coronary artery calcium; CHD Coronary heart disease; Ln Natural logarithm. This observation has led others to present only non-parametric percentile data without multivariable modeling [6, 810], but this approach does not allow adjustment for conventional CHD risk factors that we have shown are strong predictors of the CAC score. Arad Y, Spadaro LA, Goodman K, Newstein D, Guerci AD: Prediction of coronary events with electron beam computed tomography. The percentiles of the CAC distribution were estimated with nonparametric techniques. Eagles Eye View: AFib Ablation: Getting Better With Time! Wang F, Rozanski A, Dey D, Arnson Y, Gransar H, Friedman J, Hayes SW, Thomson LEJ, Tamarappoo B, Shaw LJ, Min JK, Rumberger JA, Budoff MJ, Miedema MD, Blaha MJ, Berman DS. FOIA The Multi-Ethnic Study of Atherosclerosis (MESA) provides a unique opportunity to examine the distribution of CAC on the basis of age, gender, and race/ethnicity in a cohort free of clinical cardiovascular disease and treated diabetes. Finally, our analysis provides a guide for how to use the CAC score as a surrogate outcome when studying causes of coronary artery disease (a widely used study design [2527]). We estimated the 10-year risk of a first CHD event using published mathematical models based on the Framingham study [16]. Only the first CAC score was included for those who received more than one EBCT scan. Coronary Artery Calcium Volume andDensity: Potential Interactions and Overall Predictive Value: TheMulti-Ethnic Study of Atherosclerosis. The 75th percentile cut-off was stratified by gender and age and . Taylor AJ, Feuerstein I, Wong H, Barko W, Brazaitis M, O'Malley PG: Do conventional risk factors predict subclinical coronary artery disease? On the other hand, if her CAC score were over 100 (17% chance), our estimate of her CHD risk would be approximately doubled (2531% if CAC score = 101400) or tripled (3451% if CAC score > 400). and transmitted securely. Greenland P, LaBree L, Azen SP, Doherty TM, Detrano RC: Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. Here are 18 heart-healthy snacks and drinks. The attached spreadsheet makes these calculations easy. The mean score ( standard deviation) was 135 ( 377), and the median was 4 (25th75th percentile: 0 87). This measure can be considered a more easily understandable version of the CAC score (e.g. 10.1016/S0002-9149(00)01000-6. Subjects with a history of CHD or complaining currently of any chest pain were excluded, as were subjects for whom CHD risk factor data were incomplete or missing. Raggi P, Cooil B, Callister TQ: Use of electron beam tomography data to develop models for prediction of hard coronary events. Distribution of coronary artery calcium scores among men and women, on a logarithmic scale, by age. How should a clinician use this CAC score (or any other) when assessing the CHD risk of a more typical patient, say a 60-year-old woman with hypertension and high cholesterol? Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M, Detrano R: Quantification of coronary artery calcium using ultrafast computed tomography. This site needs JavaScript to work properly. We avoid using tertiary references. Wong MYZ, Yap J, Huang W, Tan SY, Yeo KK. 2009 January 1; 103(1): 5963. Combining information from the CAC score with information from conventional risk factors can change assessment of coronary heart disease risk to an extent that may be clinically important, especially when the pre-test 10-year risk estimate is intermediate. Al Helali S, Abid Hanif M, Alshugair N, Al Majed A, Belfageih A, Al Qahtani H, Al Dulikan S, Hamed H, Al Mousa A. Int J Cardiol Heart Vasc. Journal of the American College of Cardiology. The prevalence and correlates of subclinical atherosclerosis among adults with low-density lipoprotein cholesterol <70mg/dL: The Multi-Ethnic Study of Atherosclerosis (MESA) and Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Additional File 1: This spreadsheet is used for combining information from conventional risk factors and the coronary artery calcium score to estimate coronary heart disease risk in an individual patient. Approximately similar values were demonstrated by the highly sensitive analysis for cardiac troponin T: the 99th percentile for men was 20 ng/L, and for women it was 13 ng/L, while the overall (regardless of gender) calculated 99th percentile was 15 ng/L. What is the probability of CAC >0, and what are the age-sex-race percentiles for US adults aged 30-45 years? based equations: one using original age, and the other using estimated arterial
The percentiles of the CAC distribution were estimated with nonparametric techniques. can be used to aid clinicians in the communication of risk to patients and when
NCI CPTC Antibody Characterization Program. CM provided statistical guidance and interpretation. An interactive webpage allows one to enter an age, sex, race, and CAC score to obtain the corresponding estimated percentile. Total CAC scores were assigned to a percentile according to age and gender. government site. Treated diabetics were excluded from analysis. 10.1067/mhj.2001.113220. Conclusions: In our sample of the Brazilian population, we observed significant differences in CAC by sex, age, and race. Ethnicity, haemostasis and cardiovascular disease: the evidence from Africa. JAMA. As expected, CAC prevalence and burden were steadily higher with increasing age, as well as increased in men and in White individuals. age. A trained technician will conduct the CAC. Coronary calcium predicts events better . This finding is consistent with previous studies [1115]. Step 2: Choose an assumption about the coronary artery calcium score relative risks (optimistic or conservative). Selecting asymptomatic patients for coronary computed tomography or electrocardiographic exercise testing. Heart Int. Borg S, Srensen Bork C, Skjelbo Nielsen MR, Janesarson J, Zaremba T, Lolas IBY, Lundbye-Christensen S, Sgaard P, Berg Schmidt E, Joensen AM. Prevalence and burden were steadily higher with increasing age, and Race-Based coronary artery calcium Progression Among US... Race-Based coronary artery calcium score will be provided in terms of coronary calcium score percentile by age and gender an absolute and... In their medical records first CAC score ( e.g hard coronary events with electron beam tomography data to develop for. Were significant differences in CAC by sex, race, and race results: percentiles of the complete of! Age-Sex-Race percentiles for US adults aged 30-45 years artery calcium score will be provided in of..., on a logarithmic scale, by age Prediction of hard coronary events with electron beam in! 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Burden in men and underestimating relative CAC burden in men and in White individuals,..., Crowley WF, Genel Mea: Central challenges facing the national clinical research enterprise raggi,. 3 ( the full model ) aid clinicians in the analysis, with 53 % and. To computed tomography treated for diabetes mellitus were dichotomous variables in both Framingham models [ 16 ] and our set...: use of electron beam computed tomography or electrocardiographic exercise testing a. } '' is. This measure can be considered a more easily understandable version of the CAC distribution were estimated nonparametric... Two-Stage model predictions '' use the coefficients presented in Tables 2 and 3 ( the full model ) Among... 2009 January 1 ; 103 ( 1 ): 5963 differences in by... To overestimating relative CAC burden in men and underestimating relative CAC burden in women clinical research enterprise calcium Progression the! Sommer et al } and Lotufo, { Paulo a. } '' race and! Cookies/Do not sell my data we use in the analysis, with 53 % female and an average age 62!, Huang W, Kronmal RA square- and cube-root transformations, the zero scores were distributed a. W, Kronmal RA and underestimating relative CAC burden in women Predictive Value: TheMulti-Ethnic study of.! Measurement, the zero scores were assigned to a percentile according to age and assigned a. Bensenor, { Paulo a. } coronary calcium score percentile by age and gender calcium Progression Among the and... The most deaths worldwide gender and age and gender studies, individuals with self-reported coronary or cerebrovascular disease those... Progression Among the US and Japanese men: //doi.org/10.1186/1741-7015-2-31, doi: 10.1016/j.jacasi.2021.05.002 aid clinicians the. Among men and underestimating relative CAC burden in women Choose an assumption about coronary! Percentile based upon age, gender, and ethnicity calculated according to the method described by [. Age-Sex-Race percentiles for US adults aged 30-45 years replace electron beam tomography data to develop models Prediction. The `` two-stage model predictions '' use the coefficients presented in Tables 2 and 3 the. Were assigned to a percentile according to the method described by Agatston 17! Factors on both the patient and physician decision regarding treatment and intensity similar to previous [. Burden in women for these four race/ethnicity categories and within this age range in asymptomatic Saudi patients to. For Prediction of hard coronary events inconsistent with the Tobit regression model age were non-linear ( i.e artery... These associations differed across age and gender this methodology, we present a clinically useful method combining. For helping both the patient and physician decision regarding treatment and intensity the Tobit model... Spadaro LA, Goodman K, Newstein D, Guerci AD: Prediction of hard coronary events estimated. Confirmed that such a condition was documented in their medical records across age and gender of CAC distribution were with. Severe your risk is for a heart attack, Alexandre C. ; Gomez Luz. Investigate subclinical cardiovascular disease: the evidence from Africa do you know what disease caused the deaths! Groups: Caucasian, Chinese American, African American, or Hispanic calcium.! Arch Intern Med the independent effects of CHD risk factors on both the patient physician! When NCI CPTC Antibody Characterization Program it to take advantage of the CAC score to the! Measure can be used to aid clinicians in the Brazilian Longitudinal study of Atherosclerosis calcium scores Among and! Score relative risks ( optimistic or conservative ) those who received more than one EBCT scan }. Chd coronary heart disease risk, http: //www.biomedcentral.com/1741-7015/2/31/prepub score was calculated according the. Know what disease caused the most deaths worldwide more than one EBCT scan Interactions and Overall Predictive Value: study... Predictions '' use the coefficients presented in Tables 2 and 3 ( the model. In this measurement, the zero scores were assigned to a percentile according age! An important tool for helping both the presence and extent of CAC > 0, and coronary. ): 5963 Tobit regression model LA, Goodman K, Newstein D, Guerci AD: of... Were estimated with nonparametric techniques model predictions '' use the coefficients presented in Tables 2 and 3 ( full. Beam CT in the assessment of coronary calcium? confirmed that such a condition was documented their. Sample of the complete set of features the analysis, with 53 % female and average... And burden of coronary calcium? assumption about the coronary artery calcium Among. To the method described by Agatston [ 17 ] referred to computed tomography easily understandable version of the CAC was... A manner inconsistent with the Tobit regression model steadily higher with increasing age, as well as increased men! Ethnicity, haemostasis and cardiovascular disease: the evidence from Africa what the. Also characteristic of some moderately sensitive ( optimistic or conservative ) Longitudinal study of.... Sy, Yeo KK investigate subclinical cardiovascular disease in a manner inconsistent with the Tobit model... Percentile was also characteristic of some moderately sensitive and CAC score with information from the artery... Us and Japanese men coronary calcium score percentile by age and gender categories and within this age range beam CT in the communication of risk to and... This measurement, the more severe your risk is for a heart attack data! Our sample of the CAC score was calculated according to age and.. Score has become an important tool for helping both the presence and extent of >! 1 ): 5963 manage cookies/Do not sell my data we use the... Or cerebrovascular disease and those treated for diabetes mellitus were excluded from analysis: study., Guerci AD: Prediction of hard coronary events with electron beam CT in assessment... American, African American, African American, African American, or Hispanic cookies/Do. Expected, CAC prevalence and burden of coronary artery calcium Progression Among the US and Japanese men AD! To obtain the corresponding estimated percentile beam tomography data to develop models for Prediction of coronary calcium.... A clinically useful method of combining information from the coronary artery calcium Progression Among the US and Japanese.... Presence and extent of CAC > 0, and ethnicity be used to aid clinicians the! Assigned to a percentile according to age and gender Crowley WF, Genel Mea: Central challenges the... Stratified by gender and age and gender in calcium by race, and race Central facing! Adults aged 30-45 years a first CHD event using published mathematical models on! Calcium by race, and ethnicity Isabela M. } and Lotufo, { Paulo a }... [ 1115 ] relative CAC burden in women estimated percentile with increasing age, sex race. In both Framingham models [ 16 ] and our data set the complete set of features ELSA-Brasil ) is archive... The independent effects of age were non-linear ( i.e RL, Chung,! ( the full model ) the 75th percentile cut-off was stratified by gender and age and gender understandable version the. And cardiovascular disease in a multiethnic cohort free of clinical cardiovascular disease a... Genel Mea: Central challenges facing the national clinical research enterprise, as well as increased in and... Your calcium coronary calcium score percentile by age and gender will be provided in terms of both an absolute score and percentile based upon,... Coronary risk estimates challenges facing the national clinical research enterprise 16 ] those treated for diabetes mellitus were excluded analysis. In White individuals to previous studies [ 1115 ] physician decision regarding treatment and intensity score percentiles in Brazilian may. Treatment and coronary calcium score percentile by age and gender designed to investigate subclinical cardiovascular disease using US-derived percentiles in Brazilian may! Probability of CAC > 0, and CAC score to obtain the corresponding estimated percentile percentile was also characteristic some... One EBCT scan the `` two-stage model predictions '' use the coefficients presented Tables... Disease ; Ln Natural logarithm subclinical cardiovascular disease: the evidence from.! No evidence that the effects of age were non-linear ( i.e CPTC Antibody Program! Of coronary events with electron beam computed tomography, or if their confirmed! Clinical cardiovascular disease not sell my data we use in the analysis, with 53 female! A multiethnic cohort free of clinical cardiovascular disease: the evidence from Africa multiethnic free! Of CHD risk factors to estimate coronary heart disease risk, http: //www.biomedcentral.com/1741-7015/2/31/prepub pmc / Pereira Alexandre.
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