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Erschienen in: Current Cardiovascular Imaging Reports 10/2017

01.10.2017 | Cardiac Computed Tomography (T Villines, Section Editor)

Coronary Artery Calcium Scoring: a Valuable Aid in Shared Decision Making Among Non-traditional Risk Markers

verfasst von: Anurag Mehta, Michael J. Blaha, Joseph Miller III, Parag H. Joshi

Erschienen in: Current Cardiovascular Imaging Reports | Ausgabe 10/2017

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Abstract

Purpose of the Review

The purpose of this study was to evaluate the utility of coronary artery calcium (CAC) scoring and compare it with other non-traditional cardiovascular risk markers for improvement in cardiovascular risk assessment.

Recent Findings

CAC scoring refines risk assessment among asymptomatic patients eligible for primary prevention across the spectrum of cardiovascular risk. Its use has been well-validated in several multi-ethnic population-based cohorts. With the recent ACC/AHA cholesterol treatment guidelines expanding the eligibility for statin therapy for primary prevention, the absence of CAC can be a powerful tool for identifying those at lower risk of future cardiovascular events. CAC is superior to other non-traditional risk markers recognized by the current risk assessment guidelines for re-classifying patients to appropriate risk categories and improving discrimination of risk beyond traditional risk factors.

Summary

CAC scoring is a reliable decision-making tool for improving cardiovascular risk assessment and performs better than other non-traditional risk markers, particularly when used to identify those at lower risk (i.e., CAC = 0).
Literatur
1.
Zurück zum Zitat Goff DC Jr, Lloyd-Jones DM, Bennett G, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. Circulation. 2014;129(25 Suppl 2):S49–73.CrossRefPubMed Goff DC Jr, Lloyd-Jones DM, Bennett G, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. Circulation. 2014;129(25 Suppl 2):S49–73.CrossRefPubMed
2.
Zurück zum Zitat Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. J Am Coll Cardiol. 2014;63(25 Pt B):2889–934.CrossRefPubMed Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. J Am Coll Cardiol. 2014;63(25 Pt B):2889–934.CrossRefPubMed
3.
Zurück zum Zitat Pencina MJ, Navar-Boggan AM, D'Agostino RB Sr, et al. Application of new cholesterol guidelines to a population-based sample. N Engl J Med. 2014;370(15):1422–31.CrossRefPubMed Pencina MJ, Navar-Boggan AM, D'Agostino RB Sr, et al. Application of new cholesterol guidelines to a population-based sample. N Engl J Med. 2014;370(15):1422–31.CrossRefPubMed
4.
Zurück zum Zitat Karmali KN, Goff DC Jr, Ning H, Lloyd-Jones DM. A systematic examination of the 2013 ACC/AHA pooled cohort risk assessment tool for atherosclerotic cardiovascular disease. J Am Coll Cardiol. 2014;64(10):959–68.CrossRefPubMed Karmali KN, Goff DC Jr, Ning H, Lloyd-Jones DM. A systematic examination of the 2013 ACC/AHA pooled cohort risk assessment tool for atherosclerotic cardiovascular disease. J Am Coll Cardiol. 2014;64(10):959–68.CrossRefPubMed
5.
Zurück zum Zitat Force USPST, Bibbins-Domingo K, Grossman DC, et al. Statin use for the primary prevention of cardiovascular disease in adults: US preventive services task force recommendation statement. JAMA. 2016;316(19):1997–2007.CrossRef Force USPST, Bibbins-Domingo K, Grossman DC, et al. Statin use for the primary prevention of cardiovascular disease in adults: US preventive services task force recommendation statement. JAMA. 2016;316(19):1997–2007.CrossRef
6.
Zurück zum Zitat Jellinger PS, Handelsman Y, Rosenblit PD, et al. American Association of Clinical Endocrinologists and American College of endocrinology guidelines for Management of Dyslipidemia and Prevention of cardiovascular disease. Endocr Pract. 2017;23(Suppl 2):1–87.CrossRefPubMed Jellinger PS, Handelsman Y, Rosenblit PD, et al. American Association of Clinical Endocrinologists and American College of endocrinology guidelines for Management of Dyslipidemia and Prevention of cardiovascular disease. Endocr Pract. 2017;23(Suppl 2):1–87.CrossRefPubMed
7.
Zurück zum Zitat Catapano AL, Graham I, De Backer G, et al. 2016 ESC/EAS guidelines for the Management of Dyslipidaemias. Eur Heart J. 2016;37(39):2999–3058.CrossRefPubMed Catapano AL, Graham I, De Backer G, et al. 2016 ESC/EAS guidelines for the Management of Dyslipidaemias. Eur Heart J. 2016;37(39):2999–3058.CrossRefPubMed
8.
Zurück zum Zitat Blaha MJ. The future of CV risk prediction: multisite imaging to predict multiple outcomes. JACC Cardiovasc Imaging. 2014;7(10):1054–6.CrossRefPubMed Blaha MJ. The future of CV risk prediction: multisite imaging to predict multiple outcomes. JACC Cardiovasc Imaging. 2014;7(10):1054–6.CrossRefPubMed
9.
Zurück zum Zitat Detrano R, Guerci AD, Carr JJ, et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med. 2008;358(13):1336–45.CrossRefPubMed Detrano R, Guerci AD, Carr JJ, et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med. 2008;358(13):1336–45.CrossRefPubMed
10.
Zurück zum Zitat Gibson AO, Blaha MJ, Arnan MK, et al. Coronary artery calcium and incident cerebrovascular events in an asymptomatic cohort. The MESA study. JACC Cardiovasc Imaging. 2014;7(11):1108–15.CrossRefPubMed Gibson AO, Blaha MJ, Arnan MK, et al. Coronary artery calcium and incident cerebrovascular events in an asymptomatic cohort. The MESA study. JACC Cardiovasc Imaging. 2014;7(11):1108–15.CrossRefPubMed
11.
Zurück zum Zitat Hermann DM, Gronewold J, Lehmann N, et al. Coronary artery calcification is an independent stroke predictor in the general population. Stroke. 2013;44(4):1008–13.CrossRefPubMed Hermann DM, Gronewold J, Lehmann N, et al. Coronary artery calcification is an independent stroke predictor in the general population. Stroke. 2013;44(4):1008–13.CrossRefPubMed
12.
Zurück zum Zitat Shaw LJ, Giambrone AE, Blaha MJ, et al. Long-term prognosis after coronary artery calcification testing in asymptomatic patients: a cohort study. Ann Intern Med. 2015;163(1):14–21.CrossRefPubMed Shaw LJ, Giambrone AE, Blaha MJ, et al. Long-term prognosis after coronary artery calcification testing in asymptomatic patients: a cohort study. Ann Intern Med. 2015;163(1):14–21.CrossRefPubMed
13.
Zurück zum Zitat Polonsky TS, McClelland RL, Jorgensen NW, et al. Coronary artery calcium score and risk classification for coronary heart disease prediction. JAMA. 2010;303(16):1610–6.CrossRefPubMedPubMedCentral Polonsky TS, McClelland RL, Jorgensen NW, et al. Coronary artery calcium score and risk classification for coronary heart disease prediction. JAMA. 2010;303(16):1610–6.CrossRefPubMedPubMedCentral
14.
Zurück zum Zitat Erbel R, Mohlenkamp S, Moebus S, et al. Coronary risk stratification, discrimination, and reclassification improvement based on quantification of subclinical coronary atherosclerosis: the Heinz Nixdorf recall study. J Am Coll Cardiol. 2010;56(17):1397–406.CrossRefPubMed Erbel R, Mohlenkamp S, Moebus S, et al. Coronary risk stratification, discrimination, and reclassification improvement based on quantification of subclinical coronary atherosclerosis: the Heinz Nixdorf recall study. J Am Coll Cardiol. 2010;56(17):1397–406.CrossRefPubMed
15.
Zurück zum Zitat Elias-Smale SE, Proenca RV, Koller MT, et al. Coronary calcium score improves classification of coronary heart disease risk in the elderly: the Rotterdam study. J Am Coll Cardiol. 2010;56(17):1407–14.CrossRefPubMed Elias-Smale SE, Proenca RV, Koller MT, et al. Coronary calcium score improves classification of coronary heart disease risk in the elderly: the Rotterdam study. J Am Coll Cardiol. 2010;56(17):1407–14.CrossRefPubMed
16.
Zurück zum Zitat Paixao AR, Ayers CR, El Sabbagh A, et al. Coronary artery calcium improves risk classification in younger populations. JACC Cardiovasc Imaging. 2015;8(11):1285–93.CrossRefPubMed Paixao AR, Ayers CR, El Sabbagh A, et al. Coronary artery calcium improves risk classification in younger populations. JACC Cardiovasc Imaging. 2015;8(11):1285–93.CrossRefPubMed
17.
Zurück zum Zitat Hoffmann U, Massaro JM, D'Agostino RB Sr, Kathiresan S, Fox CS, O'Donnell CJ. Cardiovascular event prediction and risk reclassification by coronary, aortic, and Valvular calcification in the Framingham heart study. J Am Heart Assoc. 2016;5(2) Hoffmann U, Massaro JM, D'Agostino RB Sr, Kathiresan S, Fox CS, O'Donnell CJ. Cardiovascular event prediction and risk reclassification by coronary, aortic, and Valvular calcification in the Framingham heart study. J Am Heart Assoc. 2016;5(2)
18.
Zurück zum Zitat Baber U, Mehran R, Sartori S, et al. Prevalence, impact, and predictive value of detecting subclinical coronary and carotid atherosclerosis in asymptomatic adults: the BioImage study. J Am Coll Cardiol. 2015;65(11):1065–74.CrossRefPubMed Baber U, Mehran R, Sartori S, et al. Prevalence, impact, and predictive value of detecting subclinical coronary and carotid atherosclerosis in asymptomatic adults: the BioImage study. J Am Coll Cardiol. 2015;65(11):1065–74.CrossRefPubMed
19.
Zurück zum Zitat Martin SS, Blaha MJ, Blankstein R, et al. Dyslipidemia, coronary artery calcium, and incident atherosclerotic cardiovascular disease: implications for statin therapy from the multi-ethnic study of atherosclerosis. Circulation. 2014;129(1):77–86.CrossRefPubMed Martin SS, Blaha MJ, Blankstein R, et al. Dyslipidemia, coronary artery calcium, and incident atherosclerotic cardiovascular disease: implications for statin therapy from the multi-ethnic study of atherosclerosis. Circulation. 2014;129(1):77–86.CrossRefPubMed
20.
Zurück zum Zitat Silverman MG, Blaha MJ, Krumholz HM, et al. Impact of coronary artery calcium on coronary heart disease events in individuals at the extremes of traditional risk factor burden: the multi-ethnic study of atherosclerosis. Eur Heart J. 2014;35(33):2232–41.CrossRefPubMed Silverman MG, Blaha MJ, Krumholz HM, et al. Impact of coronary artery calcium on coronary heart disease events in individuals at the extremes of traditional risk factor burden: the multi-ethnic study of atherosclerosis. Eur Heart J. 2014;35(33):2232–41.CrossRefPubMed
21.
Zurück zum Zitat Joshi PH, Nasir K. Discordance between risk factors and coronary artery calcium: implications for guiding treatment strategies in primary prevention settings. Prog Cardiovasc Dis. 2015;58(1):10–8.CrossRefPubMed Joshi PH, Nasir K. Discordance between risk factors and coronary artery calcium: implications for guiding treatment strategies in primary prevention settings. Prog Cardiovasc Dis. 2015;58(1):10–8.CrossRefPubMed
22.
Zurück zum Zitat • Kavousi M, Desai CS, Ayers C, et al. Prevalence and prognostic implications of coronary artery calcification in low-risk women: a meta-analysis. JAMA. 2016;316(20):2126–34. This meta-analysis of the predictive value of CAC among women from five different population-based primary prevention cohorts showed improved risk discrimination and risk reclassification in this traditionally low-risk patient population. CrossRefPubMed • Kavousi M, Desai CS, Ayers C, et al. Prevalence and prognostic implications of coronary artery calcification in low-risk women: a meta-analysis. JAMA. 2016;316(20):2126–34. This meta-analysis of the predictive value of CAC among women from five different population-based primary prevention cohorts showed improved risk discrimination and risk reclassification in this traditionally low-risk patient population. CrossRefPubMed
23.
Zurück zum Zitat Carr JJ, Jacobs DR Jr, Terry JG, et al. Association of Coronary Artery Calcium in adults aged 32 to 46 years with incident coronary heart disease and death. JAMA Cardiol. 2017;2(4):391–9.CrossRefPubMed Carr JJ, Jacobs DR Jr, Terry JG, et al. Association of Coronary Artery Calcium in adults aged 32 to 46 years with incident coronary heart disease and death. JAMA Cardiol. 2017;2(4):391–9.CrossRefPubMed
24.
Zurück zum Zitat •• RL MC, Jorgensen NW, Budoff M, et al. 10-year coronary heart disease risk prediction using coronary artery calcium and traditional risk factors: derivation in the MESA (multi-ethnic study of atherosclerosis) with validation in the HNR (Heinz Nixdorf recall) study and the DHS (Dallas heart study). J Am Coll Cardiol. 2015;66(15):1643–53. The authors incorporated CAC scores into a model containing TRFs and derived and validated a novel 10-year MESA CHD Risk Score in this study. It can be a very useful tool for communicating 10-year CHD risk to patients undergoing CAC assessment. CrossRef •• RL MC, Jorgensen NW, Budoff M, et al. 10-year coronary heart disease risk prediction using coronary artery calcium and traditional risk factors: derivation in the MESA (multi-ethnic study of atherosclerosis) with validation in the HNR (Heinz Nixdorf recall) study and the DHS (Dallas heart study). J Am Coll Cardiol. 2015;66(15):1643–53. The authors incorporated CAC scores into a model containing TRFs and derived and validated a novel 10-year MESA CHD Risk Score in this study. It can be a very useful tool for communicating 10-year CHD risk to patients undergoing CAC assessment. CrossRef
26.
Zurück zum Zitat Joshi PH. The ten year prognostic value of zero and minimal coronary artery calcium: the multi-ethnic study of atherosclerosis (MESA). 2017. Joshi PH. The ten year prognostic value of zero and minimal coronary artery calcium: the multi-ethnic study of atherosclerosis (MESA). 2017.
27.
Zurück zum Zitat Valenti V, Hartaigh B, Heo R, et al. A 15-year warranty period for asymptomatic individuals without coronary artery calcium: a prospective follow-up of 9,715 individuals. JACC Cardiovasc Imaging. 2015;8(8):900–9.CrossRefPubMedPubMedCentral Valenti V, Hartaigh B, Heo R, et al. A 15-year warranty period for asymptomatic individuals without coronary artery calcium: a prospective follow-up of 9,715 individuals. JACC Cardiovasc Imaging. 2015;8(8):900–9.CrossRefPubMedPubMedCentral
28.
Zurück zum Zitat Yeboah J, Polonsky TS, Young R, et al. Utility of nontraditional risk markers in individuals ineligible for statin therapy according to the 2013 American College of Cardiology/American Heart Association cholesterol guidelines. Circulation. 2015;132(10):916–22.CrossRefPubMedPubMedCentral Yeboah J, Polonsky TS, Young R, et al. Utility of nontraditional risk markers in individuals ineligible for statin therapy according to the 2013 American College of Cardiology/American Heart Association cholesterol guidelines. Circulation. 2015;132(10):916–22.CrossRefPubMedPubMedCentral
29.
Zurück zum Zitat Pursnani A, Massaro JM, D'Agostino RB Sr, O'Donnell CJ, Hoffmann U. Guideline-based statin eligibility, coronary artery calcification, and cardiovascular events. JAMA. 2015;314(2):134–41.CrossRefPubMedPubMedCentral Pursnani A, Massaro JM, D'Agostino RB Sr, O'Donnell CJ, Hoffmann U. Guideline-based statin eligibility, coronary artery calcification, and cardiovascular events. JAMA. 2015;314(2):134–41.CrossRefPubMedPubMedCentral
30.
Zurück zum Zitat •• Nasir K, Bittencourt MS, Blaha MJ, et al. Implications of coronary artery calcium testing among statin candidates according to American College of Cardiology/American Heart Association cholesterol management guidelines: MESA (multi-ethnic study of atherosclerosis). J Am Coll Cardiol. 2015;66(15):1657–68. This study solidified the consensus that CAC=0 can be used to ‘de-risk’ individuals with statin eligibility per the ACC/AHA guidelines. The authors observed that the 10-year ASCVD event rate among non-diabetic MESA participants with CAC=0 and 7.5 to 20% 10-year ASCVD risk was below the threshold for statin initiation. CrossRefPubMed •• Nasir K, Bittencourt MS, Blaha MJ, et al. Implications of coronary artery calcium testing among statin candidates according to American College of Cardiology/American Heart Association cholesterol management guidelines: MESA (multi-ethnic study of atherosclerosis). J Am Coll Cardiol. 2015;66(15):1657–68. This study solidified the consensus that CAC=0 can be used to ‘de-risk’ individuals with statin eligibility per the ACC/AHA guidelines. The authors observed that the 10-year ASCVD event rate among non-diabetic MESA participants with CAC=0 and 7.5 to 20% 10-year ASCVD risk was below the threshold for statin initiation. CrossRefPubMed
31.
Zurück zum Zitat Mortensen MB, Fuster V, Muntendam P, et al. A simple disease-guided approach to personalize ACC/AHA-recommended statin allocation in elderly people: the BioImage study. J Am Coll Cardiol. 2016;68(9):881–91.CrossRefPubMed Mortensen MB, Fuster V, Muntendam P, et al. A simple disease-guided approach to personalize ACC/AHA-recommended statin allocation in elderly people: the BioImage study. J Am Coll Cardiol. 2016;68(9):881–91.CrossRefPubMed
32.
Zurück zum Zitat Mahabadi AA, Mohlenkamp S, Lehmann N, et al. CAC score improves coronary and CV risk assessment above statin indication by ESC and AHA/ACC primary prevention guidelines. JACC Cardiovasc Imaging. 2017;10(2):143–53.CrossRefPubMed Mahabadi AA, Mohlenkamp S, Lehmann N, et al. CAC score improves coronary and CV risk assessment above statin indication by ESC and AHA/ACC primary prevention guidelines. JACC Cardiovasc Imaging. 2017;10(2):143–53.CrossRefPubMed
33.
Zurück zum Zitat Peters SA, den Ruijter HM, Bots ML, Moons KG. Improvements in risk stratification for the occurrence of cardiovascular disease by imaging subclinical atherosclerosis: a systematic review. Heart. 2012;98(3):177–84.CrossRefPubMed Peters SA, den Ruijter HM, Bots ML, Moons KG. Improvements in risk stratification for the occurrence of cardiovascular disease by imaging subclinical atherosclerosis: a systematic review. Heart. 2012;98(3):177–84.CrossRefPubMed
34.
Zurück zum Zitat Rana JS, Gransar H, Wong ND, et al. Comparative value of coronary artery calcium and multiple blood biomarkers for prognostication of cardiovascular events. Am J Cardiol. 2012;109(10):1449–53.CrossRefPubMed Rana JS, Gransar H, Wong ND, et al. Comparative value of coronary artery calcium and multiple blood biomarkers for prognostication of cardiovascular events. Am J Cardiol. 2012;109(10):1449–53.CrossRefPubMed
35.
Zurück zum Zitat • Yeboah J, McClelland RL, Polonsky TS, et al. Comparison of novel risk markers for improvement in cardiovascular risk assessment in intermediate-risk individuals. JAMA. 2012;308(8):788–95. This MESA analysis demonstrated CAC to be superior for risk discrimination and reclassification among the four non-traditional risk markers recommended by the ACC/AHA risk assessment guidelines. CrossRefPubMedPubMedCentral • Yeboah J, McClelland RL, Polonsky TS, et al. Comparison of novel risk markers for improvement in cardiovascular risk assessment in intermediate-risk individuals. JAMA. 2012;308(8):788–95. This MESA analysis demonstrated CAC to be superior for risk discrimination and reclassification among the four non-traditional risk markers recommended by the ACC/AHA risk assessment guidelines. CrossRefPubMedPubMedCentral
36.
Zurück zum Zitat Kavousi M, Elias-Smale S, Rutten JH, et al. Evaluation of newer risk markers for coronary heart disease risk classification: a cohort study. Ann Intern Med. 2012;156(6):438–44.CrossRefPubMed Kavousi M, Elias-Smale S, Rutten JH, et al. Evaluation of newer risk markers for coronary heart disease risk classification: a cohort study. Ann Intern Med. 2012;156(6):438–44.CrossRefPubMed
37.
Zurück zum Zitat Yeboah J, Young R, McClelland RL, et al. Utility of nontraditional risk markers in atherosclerotic cardiovascular disease risk assessment. J Am Coll Cardiol. 2016;67(2):139–47.CrossRefPubMedPubMedCentral Yeboah J, Young R, McClelland RL, et al. Utility of nontraditional risk markers in atherosclerotic cardiovascular disease risk assessment. J Am Coll Cardiol. 2016;67(2):139–47.CrossRefPubMedPubMedCentral
38.
Zurück zum Zitat Geisel MH, Bauer M, Hennig F, et al. Comparison of coronary artery calcification, carotid intima-media thickness and ankle-brachial index for predicting 10-year incident cardiovascular events in the general population. Eur Heart J. 2017; Geisel MH, Bauer M, Hennig F, et al. Comparison of coronary artery calcification, carotid intima-media thickness and ankle-brachial index for predicting 10-year incident cardiovascular events in the general population. Eur Heart J. 2017;
39.
Zurück zum Zitat Fontana M, Asaria P, Moraldo M, et al. Patient-accessible tool for shared decision making in cardiovascular primary prevention: balancing longevity benefits against medication disutility. Circulation. 2014;129(24):2539–46.CrossRefPubMedPubMedCentral Fontana M, Asaria P, Moraldo M, et al. Patient-accessible tool for shared decision making in cardiovascular primary prevention: balancing longevity benefits against medication disutility. Circulation. 2014;129(24):2539–46.CrossRefPubMedPubMedCentral
40.
Zurück zum Zitat •• Blaha MJ, Cainzos-Achirica M, Greenland P, et al. Role of coronary artery calcium score of zero and other negative risk markers for cardiovascular disease: the multi-ethnic study of atherosclerosis (MESA). Circulation. 2016;133(9):849–58. This study emphasizes the superiority of CAC=0 as compared to other negative non-traditional risk markers. Absence of CAC was observed to have the greatest impact on accurately reducing posttest risk (risk after the knowledge of a negative non-traditional risk marker) of CHD and CVD among MESA participants. CrossRefPubMedPubMedCentral •• Blaha MJ, Cainzos-Achirica M, Greenland P, et al. Role of coronary artery calcium score of zero and other negative risk markers for cardiovascular disease: the multi-ethnic study of atherosclerosis (MESA). Circulation. 2016;133(9):849–58. This study emphasizes the superiority of CAC=0 as compared to other negative non-traditional risk markers. Absence of CAC was observed to have the greatest impact on accurately reducing posttest risk (risk after the knowledge of a negative non-traditional risk marker) of CHD and CVD among MESA participants. CrossRefPubMedPubMedCentral
41.
Zurück zum Zitat Hecht H, Blaha MJ, Berman DS, et al. Clinical indications for coronary artery calcium scoring in asymptomatic patients: expert consensus statement from the Society of Cardiovascular Computed Tomography. J Cardiovasc Comput Tomogr. 2017;11(2):157–68.CrossRefPubMed Hecht H, Blaha MJ, Berman DS, et al. Clinical indications for coronary artery calcium scoring in asymptomatic patients: expert consensus statement from the Society of Cardiovascular Computed Tomography. J Cardiovasc Comput Tomogr. 2017;11(2):157–68.CrossRefPubMed
42.
Zurück zum Zitat Tison GH, Guo M, Blaha MJ, et al. Multisite extracoronary calcification indicates increased risk of coronary heart disease and all-cause mortality: the multi-ethnic study of atherosclerosis. J Cardiovasc Comput Tomogr. 2015;9(5):406–14.CrossRefPubMedPubMedCentral Tison GH, Guo M, Blaha MJ, et al. Multisite extracoronary calcification indicates increased risk of coronary heart disease and all-cause mortality: the multi-ethnic study of atherosclerosis. J Cardiovasc Comput Tomogr. 2015;9(5):406–14.CrossRefPubMedPubMedCentral
43.
Zurück zum Zitat Blaha MJ, Budoff MJ, Tota-Maharaj R, et al. Improving the CAC score by addition of regional measures of calcium distribution: multi-ethnic study of atherosclerosis. JACC Cardiovasc Imaging. 2016;9(12):1407–16.CrossRefPubMed Blaha MJ, Budoff MJ, Tota-Maharaj R, et al. Improving the CAC score by addition of regional measures of calcium distribution: multi-ethnic study of atherosclerosis. JACC Cardiovasc Imaging. 2016;9(12):1407–16.CrossRefPubMed
44.
Zurück zum Zitat Paixao AR, Berry JD, Neeland IJ, et al. Coronary artery calcification and family history of myocardial infarction in the Dallas heart study. JACC Cardiovasc Imaging. 2014;7(7):679–86.CrossRefPubMed Paixao AR, Berry JD, Neeland IJ, et al. Coronary artery calcification and family history of myocardial infarction in the Dallas heart study. JACC Cardiovasc Imaging. 2014;7(7):679–86.CrossRefPubMed
45.
Zurück zum Zitat Mody P, Joshi PH, Khera A, Ayers CR, Rohatgi A. Beyond coronary calcification, family history, and C-reactive protein: cholesterol efflux capacity and cardiovascular risk prediction. J Am Coll Cardiol. 2016;67(21):2480–7.CrossRefPubMedPubMedCentral Mody P, Joshi PH, Khera A, Ayers CR, Rohatgi A. Beyond coronary calcification, family history, and C-reactive protein: cholesterol efflux capacity and cardiovascular risk prediction. J Am Coll Cardiol. 2016;67(21):2480–7.CrossRefPubMedPubMedCentral
Metadaten
Titel
Coronary Artery Calcium Scoring: a Valuable Aid in Shared Decision Making Among Non-traditional Risk Markers
verfasst von
Anurag Mehta
Michael J. Blaha
Joseph Miller III
Parag H. Joshi
Publikationsdatum
01.10.2017
Verlag
Springer US
Erschienen in
Current Cardiovascular Imaging Reports / Ausgabe 10/2017
Print ISSN: 1941-9066
Elektronische ISSN: 1941-9074
DOI
https://doi.org/10.1007/s12410-017-9431-3

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