Studies Suggest Coronary Calcium Scores Can Assess Long-Term Risk for Heart Disease

Studies Suggest Coronary Calcium Scores Can Assess Long-Term Risk for Heart Disease
Despite being available for decades, CT-based coronary artery calcium scoring has been subject to debate among doctors on whether, and how, it should be used to inform patient care. Utilizing data from five separate studies, researchers have concluded that coronary artery calcium scoring can provide an early indication of a person’s long-term risk for heart disease. The results of the five studies were presented as part of ACC.14.

“[These] studies suggest that we may have been underestimating the value of calcium scoring for detecting and managing patients with known or suspected coronary disease,” says Kim Allan Williams, Sr., MD, vice president of the ACC and chief of cardiology at Rush University Medical Center in Chicago.

Included in the various research ventures was Su Min Chang, MD, whose team investigated the utility coronary artery calcium scoring as a first-line test for people without any cardiac symptoms. Following 1,000 people for an average of seven years, Chang found that coronary artery calcium scores were significantly better at predicting cardiac events than the Framingham 10-year risk calculator and the exercise treadmill test.

Additionally bolstering the case for calcium scoring was a study led by Rine Nakanishi, MD, PhD, and Matthew Budoff, MD, which entailed a 20-year examination of nearly 5,600 patients. Over an average follow-up period of 10 years, Nakanishi, Budoff, and their colleagues found that even patients with a low calcium score (1-99) were 50 percent more likely to die of heart disease than patients with a calcium score of zero. Moderate scores (100-399) were associated with an 80 percent likelihood and high scores (above 400) were associated with a three times greater risk compared to patients with a score of zero.

Another study contributing to the discussion was led by Ronen Rubinshtein, MD, who found that coronary calcium score was superior to other computed tomography (CT)-based measures of a person’s heart health. Tracking the long-term (i.e. eight years) likelihood of death or heart attack among 620 patients who were referred to CT scanning after experiencing chest pain but who had not been previously diagnosed with coronary artery disease, the study compared three measurements from the scans: the coronary calcium score, atheroma and luminal stenosis. Of the three, the coronary calcium score was found to be the only independent CT predictor of death or heart attacks long-term.

In yet another study, calcification in the coronary arteries was analyzed in the context of overall health. Analyzing the demographic and lifestyle risk factors of 1,850 participants, lead author Seamus Whelton, MD, and his colleagues found that no single risk factor predicted which individuals would maintain a coronary artery calcium score of zero over a 10-year period. Young participants and those without multiple traditional cardiovascular risk factors were more likely to maintain a calcium score of zero during a second scan taken 10 years later. This implies that healthy arterial aging appears to be influenced predominately by the long-term maintenance of a healthy lifestyle rather than any one specific risk factor.

Finally, a meta-analysis of 17 studies found a rough correlation between coronary calcium scores and the results of SPECT-MPI, a common imaging procedure that is used to detect coronary heart disease. Led by Chirag Bavishi, MD, MPH, the study revealed that calcium scores of zero are generally associated with negative SPECT-MPI results. Thus, while the tests reflect different aspects of heart health (anatomical versus functional), the two tests can be viewed as complementary.