1Department of Radiology, Baotou Central Clinical Medicine College, Inner Mongolia Medical University, Inner Mongolia 014040, China, 2Department of Cardiovascular Medicine, Research Center for Translational Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200135,China, 3Department of Radiology, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China, 4Baotou Medical Collage, Inner Mongolia 014040, China
TABLE OF CONTENTS
- 1. Abstract
- 2. Introduction
- 3. Methods
- 3.1. Search strategy
- 3.2. Inclusion and exclusion criteria
- 3.3. Subjects
- 3.4. Assessment scale
- 3.5. Search results
- 3.6. Study quality
- 3.7. Statistical methods
- 4. Results
- 4.1. Baseline characteristics of the participants
- 4.2. Quality assessment
- 5. Discussion
- 6. Acknowledgments
- 7. References
We investigated coronary heart disease (CHD) and cardiovascular disease (CVD) event rates in a diverse population with a coronary artery calcium score (CACS) of 0 and the role of CACS in the detection of subclinical noncalcified atherosclerotic plaque. A total of 15,884 participants in five studies were included in this meta-analysis. Hazard ratios (HRs) with 95% confidence intervals (95% CIs) were calculated. The results showed that CHD incidence significantly increased with increased CACS (HR=0.05, 95% CI 0.03–0.06, Z=5.82, P=0.002). The CHD rate was low and further increased with CACS of 101–300. With CACS >300, the CHD rate was highest. Similarly, CVD rate was low with CACS of 0, increased with CACS of 1–100 (HR=0.03, 95% CI 0.01–0.06, Z=1.66, P=0.096), and further increased with CACS of 101–300. With CACS >300, the CVD rate was highest. Clinical evidence indicated that the higher the CACS, the higher the CHD and CVD rates, while the CVD rate does not always decreased compared with CHD rate with the same CACS, especially with CACS of 0.
1. M. J. Bom, P. M. Van der Zee, F. M. Van der Zant, R. J. Knol and J. H. Cornel: Independent prognostic value of coronary artery calcium score and coronary computed tomography angiography in an outpatient cohort of low to intermediate risk chest pain patients.
2. M. J. Blaha, M. J. Budoff, R. Tota-Maharaj, Z. A. Dardari, N. D. Wong, R. A. Kronmal, J. Eng, W. S. Post, R. S. Blumenthal and K. Nasir: Improving the CAC Score by Addition of Regional Measures of Calcium Distribution: Multi-Ethnic Study of Atherosclerosis.
3. A. P. G. W. Group, K. S. Beck, J. A. Kim, Y. H. Choe, S. K. Hian, J. Hoe, Y. J. Hong, S. M. Kim, T. H. Kim, Y. J. Kim, Y. H. Kim, S. Kuribayashi, J. Lee, L. Leong, T. H. Lim, B. Lu, J. H. Park, H. Sakuma, D. H. Yang, T. S. Yaw, Y. L. Wan, Z. Zhang, S. Zhao and H. S. Yong: 2017 Multimodality Appropriate Use Criteria for Noninvasive Cardiac Imaging: Expert Consensus of the Asian Society of Cardiovascular Imaging.
4. D. H. Lee, H. J. Youn, H. O. Jung, K. Chang, Y. S. Choi and J. I. Jung: Coronary artery calcium score plays an important role for cardiovascular risk stratification in the statin benefit groups of asymptomatic individuals.
5. P. H. Joshi, B. Patel, M. J. Blaha, J. D. Berry, R. Blankstein, M. J. Budoff, N. Wong, A. Agatston, R. S. Blumenthal and K. Nasir: Coronary artery Calcium predicts Cardiovascular events in participants with a low lifetime risk of Cardiovascular disease: The Multi-Ethnic Study of Atherosclerosis (MESA).
6. P. de Araujo Goncalves, A. Hideo-Kajita and H. M. Garcia-Garcia: Impact of plaque characteristics on the degree of functional stenosis.
7. X. R. Feng, L. H. Liang, J. F. Wu, Y. Q. Chen and S. Liang: 64-Slice spiral double-low CT to evaluate the degree of stenosis and plaque composition in diagnosing coronary artery disease.
8. F. Cademartiri, S. Seitun, A. Clemente, L. La Grutta, P. Toia, G. Runza, M. Midiri and E. Maffei: Myocardial blood flow quantification for evaluation of coronary artery disease by computed tomography.
9. X. Duan, Z. Li, L. Yu, S. Leng, A. F. Halaweish, J. G. Fletcher and C. H. McCollough: Characterization of Urinary Stone Composition by Use of Third-Generation Dual-Source Dual-Energy CT With Increased Spectral Separation.
10. B.J. Michael , M. Cainzos-Achirica, G. Philip, M. W. John, B. Ron , B. J.Matthew, D. Zeina , S. T. Christopher , B. L. Gregory , K. A. Richard , S. Moyses , B. S. Roger, N. Khurram:Role of Coronary Artery Calcium Score of Zero and Other Negative Risk Markers for Cardiovascular Disease: The Multi-Ethnic Study Of Atherosclerosis (MESA) . Circulation.133(9): 849–858.(2016)
12. Y. Urabe, H. Yamamoto, T. Kitagawa, H. Utsunomiya, H. Tsushima, F. Tatsugami, K. Awai and Y. Kihara: Identifying Small Coronary Calcification in Non-Contrast 0.5.-mm Slice Reconstruction to Diagnose Coronary Artery Disease in Patients with a Conventional Zero Coronary Artery Calcium Score.
13. D. R. Obaid, P. A. Calvert, A. Brown, D. Gopalan, N. E. J. West, J. H. F. Rudd and M. R. Bennett: Coronary CT angiography features of ruptured and high-risk atherosclerotic plaques: Correlation with intra-vascular ultrasound.
14. J. Patel, M. Al Rifai, M. J. Blaha, M. J. Budoff, W. S. Post, J. F. Polak, D. A. Bluemke, M. T. Scheuner, R. A. Kronmal, R. S. Blumenthal, K. Nasir and J. W. McEvoy: Coronary Artery Calcium Improves Risk Assessment in Adults With a Family History of Premature Coronary Heart Disease: Results From Multiethnic Study of Atherosclerosis.
15. R. Blankstein, A. Gupta, J. S. Rana and K. Nasir: The Implication of Coronary Artery Calcium Testing for Cardiovascular Disease Prevention and Diabetes.
16. N. T. Mari Hangai, Hiroyuki Honma, Atsumi Sasaki, Ai Chida, Rieko Nakano, Hirobumi Togashi, Riyuki Nakagawa, Tomoyasu Oda, Mizue Matsui, Satoshi Yashiro, Kan Nagasawa, Takashi Kajiwara, Kazuma Takahashi, Yoshihiko Takahashi, Jo Satoh, Yasushi Ishigaki: Association of Advanced Glycation End Products with coronary Artery Calcification in Japanese Subjects with Type 2 Diabetes as Assessed by Skin Autofluorescence.
17. N. B. Radford, L. F. DeFina, C. E. Barlow, S. G. Lakoski, D. Leonard, A. R. Paixao, A. Khera and B. D. Levine: Progression of CAC Score and Risk of Incident CVD.
18. D. A. D. Michael D Miedema, Jeffrey R Misialek, Michael J Blaha, Khurram Nasir, Michael G Silverman, Ron Blankstein, Matthew J Budoff, Philip Greenland, Aaron R Folsom: The Use of Coronary Artery Calcium Testing to Guide Aspirin Utilization for Primary Prevention: Estimates from the Multi-Ethnic Study of Atherosclerosis.
19. L. Jorgensen, A. S. Paludan-Muller, D. R. Laursen, J. Savovic, I. Boutron, J. A. Sterne, J. P. Higgins and A. Hrobjartsson: Evaluation of the Cochrane tool for assessing risk of bias in randomized clinical trials: overview of published comments and analysis of user practice in Cochrane and non-Cochrane reviews.
20. M. G. Silverman, M. J. Blaha, H. M. Krumholz, M. J. Budoff, R. Blankstein, C. T. Sibley, A. Agatston, R. S. Blumenthal and K. Nasir: 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.
21. U. Hoffmann, J. M. Massaro, R. B. D'Agostino, Sr., S. Kathiresan, C. S. Fox and C. J. O'Donnell: Cardiovascular Event Prediction and Risk Reclassification by Coronary, Aortic, and Valvular Calcification in the Framingham Heart Study.
22. S. Y. Tay, P. Y. Chang, W. T. Lao, Y. C. Lin, Y. H. Chung and W. P. Chan: The proper use of coronary calcium score and coronary computed tomography angiography for screening asymptomatic patients with cardiovascular risk factors.
23. K. B. Won, H. J. Chang, H. Niinuma, J. Sung, S. Shin, I. J. Cho, C. Y. Shim, G. R. Hong, Y. J. Kim, B. W. Choi and N. Chung: Evaluation of the predictive value of coronary artery calcium score for obstructive coronary artery disease in asymptomatic Korean patients with type 2 diabetes mellitus.
24. P. K. Shah: Temporal Change in CAC Score and Prognosis: Follow-Up Score Is Simpler and as Good as a Change in Score.
25. H.-J. Y. Dong-Hyeon Lee, Hae-Ok Jung, Kiyuk Chang, Yun-Seok Choi, Jung Im Jung: The cardiovascular risk factors associated with the plaque pattern on coronary computed tomographic angiography in subjects for health check-up.
26. X. Liu, G. Wu, C. Xu, Y. He, L. Shu, Y. Liu, N. Zhang and C. Lin: Quantitative Evaluation of Coronary Plaque Progression by Computed Tomographic Angiography.
27. K. Takamura, S. Fujimoto, T. Kondo, M. Hiki, Y. Kawaguchi, E. Kato and H. Daida: Incremental Prognostic Value of Coronary Computed Tomography Angiography: High-Risk Plaque Characteristics in Asymptomatic Patients.
28. A. O. Gibson, M. J. Blaha, M. K. Arnan, R. L. Sacco, M. Szklo, D. M. Herrington and J. Yeboah: Coronary artery calcium and incident cerebrovascular events in an asymptomatic cohort. The MESA Study.
29. M. J. Blaha, M. J. Budoff, A. P. DeFilippis, R. Blankstein, J. J. Rivera, A. Agatston, D. H. O'Leary, J. Lima, R. S. Blumenthal and K. Nasir: Associations between C-reactive protein, coronary artery calcium, and cardiovascular events: implications for the JUPITER population from MESA, a population-based cohort study.
30. J. F. Polak, M. Szklo and D. H. O'Leary: Carotid Intima-Media Thickness Score, Positive Coronary Artery Calcium Score, and Incident Coronary Heart Disease: The Multi-Ethnic Study of Atherosclerosis.
31. M. Zaid, A. Fujiyoshi, A. Kadota, R. D. Abbott and K. Miura: Coronary Artery Calcium and Carotid Artery Intima Media Thickness and Plaque: Clinical Use in Need of Clarification.
32. E. J. Benjamin, M. J. Blaha, S. E. Chiuve, M. Cushman, S. R. Das, R. Deo, S. D. de Ferranti, J. Floyd, M. Fornage, C. Gillespie, C. R. Isasi, M. C. Jimenez, L. C. Jordan, S. E. Judd, D. Lackland, J. H. Lichtman, L. Lisabeth, S. Liu, C. T. Longenecker, R. H. Mackey, K. Matsushita, D. Mozaffarian, M. E. Mussolino, K. Nasir, R. W. Neumar, L. Palaniappan, D. K. Pandey, R. R. Thiagarajan, M. J. Reeves, M. Ritchey, C. J. Rodriguez, G. A. Roth, W. D. Rosamond, C. Sasson, A. Towfighi, C. W. Tsao, M. B. Turner, S. S. Virani, J. H. Voeks, J. Z. Willey, J. T. Wilkins, J. H. Wu, H. M. Alger, S. S. Wong, P. Muntner, C. American Heart Association Statistics and S. Stroke Statistics: Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association.
33. C.Randy , B. Matthew , M. L. Robyn , S. Stefan, B. Gregory, B. Michael , S. Moyses, U. Seth , R. Alan, S. Steven: Significance of a Positive Family History for Coronary Heart Disease in Patients with a Zero Coronary Artery CalciumScore (From the Multi-Ethnic Study of Atherosclerosis [MESA]).
Abbreviations: CHD: coronary heart disease; CVD: cardiovascular disease; cardiovascular disease: coronary artery calcium score; HRs: Hazard ratios; CT: Computed tomography, CCTA: Coronary CT angiography, Review
Key Words :Computed tomography, CT, Coronary artery calcium score, CACS, Coronary heart disease, CHD, Cardiovascular disease, CVD
Send correspondence to: Kai Sun, Department of Radiology, Baotou Central Clinical Medicine College, Inner Mongolia Medical University, Inner Mongolia 014040, China, Tel: 86-018804723588, Fax: 86-2164085875, E-mail: Henrysk@163.com