Author + information
- Received November 24, 2009
- Revision received June 14, 2010
- Accepted June 15, 2010
- Published online November 9, 2010.
- John W. McEvoy, MB*,* (, )
- Michael J. Blaha, MD, MPH*,
- Andrew P. DeFilippis, MD, MSc*,
- Matthew J. Budoff, MD†,
- Khurram Nasir, MD, MPH*,‡,
- Roger S. Blumenthal, MD* and
- Steven R. Jones, MD*
- ↵*Reprint requests and correspondence:
John W. McEvoy, Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, 600 North Wolfe Street, Carnegie 568B, Baltimore, Maryland 21287
Baseline coronary artery calcification (CAC) accurately identifies coronary atherosclerosis and might improve prediction of future cardiac events. Serial assessment of CAC scores has been proposed for monitoring atherosclerosis progression and for assessing the effectiveness of medical therapies aimed at reducing cardiac risk. However, whether knowledge of progression of CAC scores over time further improves risk prediction is unclear. Several trials relating medical therapies to CAC progression have been performed without any formal guidelines on the definition of CAC progression and how it is best quantified. We conducted a comprehensive review of published reports on CAC progression. Increased CAC progression is associated with many known cardiac risk factors. We found that CAC progression correlates with worsening atherosclerosis and may facilitate prediction of future cardiac events. These findings support the notion that slowing CAC progression with therapeutic interventions might provide prognostic benefit. However, despite promising early data, such interventions (most notably with statin therapy) have not been shown to slow the progression of CAC in any randomized controlled trial to date, outside of post hoc subgroup analyses. Thus, routine quantification of CAC progression cannot currently be recommended in clinical practice. First, standards of how CAC progression should be defined and assessed need to be developed. In addition, there remains a need for further studies analyzing the effect of other cardiac therapies on CAC progression and cardiac outcomes.
Dr. DeFilippis is supported by a National Research Service Award (NRSA) TrainingGrant (T32-HL-07227). Dr. Budoff is on the Speakers' Bureau of GE. Dr. Jones has received research grant support from Atherotechand served as a consultant to Abbott Pharmaceuticals. All other authors have reported that they have no relationships to disclose.
- Received November 24, 2009.
- Revision received June 14, 2010.
- Accepted June 15, 2010.
- American College of Cardiology Foundation
- Pathophysiology of CAC Progression
- Measuring CAC Progression
- Clinical Determinants of CAC Progression
- Clinical Implications of CAC Progression
- CAC Progression and Therapeutic Interventions
- Statin Studies
- Nonstatin Studies
- Recommendations and Future Directions