coronary calcium score percentile by age and gender

Our analysis has a number of limitations, perhaps the most important being a lack of clinical detail about participants. Use of the coronary artery calcium score (CAC) to assist in risk stratification of asymptomatic men and women is effective but limited to ages 45-84 years. Results: Percentiles of CAC distribution were estimated with nonparametric techniques. 2000, 36: 1253-60. Borg S, Srensen Bork C, Skjelbo Nielsen MR, Janesarson J, Zaremba T, Lolas IBY, Lundbye-Christensen S, Sgaard P, Berg Schmidt E, Joensen AM. The CAC score is fundamentally not normally distributed because of the large percentage of zero measurements, and hence is not amenable to a normalizing transformation, as noted by others [13]. Step 1: Enter your patient's clinical information (the red numbers). Would you like email updates of new search results? Another important limitation of this study is our lack of data on race/ethnicity our results may not apply to all ethnic groups. Background: Blumenthal, MD, and Richard A. Kronmal, PhD. Am J Cardiol. 10.1016/S1047-2797(02)00277-6. 1995, 70: 223-32. Distribution of Coronary Artery Calcium by Age, Sex, and Race Among Patients 30-45 Years Old. We then used published model coefficients [16] to estimate the 10-year risk for each patient in our study. The analysis included 3616 individuals (54% female; mean age, 50 years). Our analysis suggests that a two-step approach (using first logistic regression to model the risk of having a non-zero score, then linear regression of log-transformed non-zero CAC scores to model the extent of coronary calcification) will allow multivariable analysis of the interval data provided by the CAC score without violating the basic assumptions of parametric statistics. Mayo Clin Proc. Your doctor may also order additional tests depending on your CAC score. While others have proposed similar Bayesian approaches to use of the CAC score for coronary risk prediction [6, 2124], ours has advantages. As expected, CAC prevalence and burden were steadily higher with increasing age, as well as increased in men and in White individuals. Open Heart. Treatments for coronary artery disease include lifestyle changes, medications, and additional procedures in some cases. For this purpose, we assumed that subjects reporting hypertension had systolic blood pressures of 140160 mmHg and/or diastolic blood pressures of 90100 mmHg (Stage I hypertension), and that subjects without hypertension had systolic pressures of 120130 and diastolic pressures of 8085 mmHg. J Am Coll Cardiol. After exclusion of zero values, however, the log-transformed CAC score was approximately normally distributed (Figure 1). Mayo Clin Proc. PubMed Aggressive primary prevention of coronary heart disease (CHD) is most appropriate in patients at relatively high risk of CHD events [1, 2]. I would be concerned that a CAC = 0 would suggest to the patient and provider that the risk factors do not need to be treated. Our results revealed that for a given CAC score, the ELSA-derived CAC percentile would be lower in men compared with the Multi-Ethnic Study of Atherosclerosis (MESA) and would be higher in women compared with MESA. We also assumed that patients with high cholesterol had low-density lipoprotein (LDL) cholesterol levels of 130159 mg/dl and high density lipoprotein (HDL) cholesterol levels of 3544 mg/dl, whereas patients without high cholesterol had LDL cholesterol levels of 100129 mg/dl and HDL cholesterol levels of 4549 mg/dl (for men) or 5059 mg/dl (for women). Overall, Chinese and black women were intermediate, with their order dependent on age. See this image and copyright information in PMC. This analysis confirms that conventional risk factors for CHD (hypertension, diabetes, smoking and high cholesterol, as well as increasing age and male sex) are independent predictors of coronary artery calcification. The prevalence of zero scores ranged from 80% among women younger than 50 years to 5% among men 70 years old or older. After weighting each cohort equally, the probability of CAC >0 and age-sex-race percentiles of CAC distributions were estimated using nonparametric techniques. Patients were labeled as smokers if they currently smoked or had quit smoking within the preceding 3 months. Abbreviations: CAC, coronary artery calcium; ELSA, Brazilian Longitudinal Study of Adult Health; MESA, MultiEthnic Study of Atherosclerosis. a patient is "high risk", but can indicate whether they have a high calcium At the MESA public website (http://www.mesa-nhlbi.org), an interactive form allows one to enter an age, gender, race/ethnicity, and CAC score to obtain a corresponding estimated percentile. risk-equivalent of coronary artery calcium. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is a prospective cohort study designed to investigate subclinical cardiovascular disease in 6 different centers of Brazil. Ethnicity, haemostasis and cardiovascular disease: the evidence from Africa. Similar to previous studies, individuals with self-reported coronary or cerebrovascular disease and those treated for diabetes mellitus were excluded from analysis. Adjusted for age and sex, low-risk individuals from the Brazilian population present with significantly lower CAC prevalence and burden compared with other low-risk individuals from other worldwide populations. Subclinical atherosclerosis determined by coronary artery calcium deposition in patients with clinical familial hypercholesterolemia. CAC score >75th percentile, n (%) 13 (12.4) CAD, n (%) 44 (41.9) . 10.1016/S0002-9149(02)02636-X. All persons referred by their physician to an electron beam computed tomography (EBCT) scanning center in Nashville, Tennessee for measurement of coronary artery calcification between May 15, 1995 and December 31, 1997 were eligible for inclusion. Please enable it to take advantage of the complete set of features! use of anti-hypertensive medication (yes/no), any family history Estimated Percentiles of CAC by Age Category, Gender, and Race/Ethnicity. The first bar represents subjects with no detectable CAC, which corresponds to an undefined Ln(CAC) value. Al Rifai M, Martin SS, McEvoy JW, Nasir K, Blankstein R, Yeboah J, Miedema M, Shea SJ, Polak JF, Ouyang P, Blumenthal RS, Bittencourt M, Bensenor I, Santos RD, Duncan BB, Santos IS, Lotufo PA, Blaha MJ. The NCEP (ATP III) has recommended age-gender cutpoints; "In persons with multiple risk factors, high coronary calcium scores (e.g., >75 th percentile for age and sex) denotes advanced coronary atherosclerosis and provides a rationale for intensified LDL-lowering therapy." 7 However, the results of MESA indicate that the relative . The logistic model with age, sex and all CHD risk factors produced the most accurate model (C-statistic = 0.78). 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. What does my patient's coronary artery calcium score mean? provide the estimated percentile for this particular score. and transmitted securely. Smoking and diabetes mellitus were dichotomous variables in both Framingham models [16] and our data set. Using US-derived percentiles in Brazilian individuals may lead to overestimating relative CAC burden in men and underestimating relative CAC burden in women. The MESA risk score, which is available online on the MESA web site for easy use, Finally, our data are limited in application to CAC scores measured by electron beam computed tomography with 3 mm slice thickness and the described protocol. score relative to others with the same age, gender, and race/ethnicity. Manage cookies/Do not sell my data we use in the preference centre. Total CAC scores were assigned to a percentile according to age and gender. Journal of the American College of Cardiology. Using the case example presented in the Background section, we calculated that a 60-year-old woman with Stage I hypertension (140/90 mmHg) and high cholesterol (LDL cholesterol = 155 mg/dl, HDL cholesterol = 40 mg/dl) will have a 15% risk of suffering a CHD event in 10 years, according to the Framingham equation. The CAC distribution, stratified for age, gender and race, is similar to the previously described distribution in the MESA study. To use CAC Score Reference Values web tool please click 'Start' button below: Arterial age provides a convenient transformation of coronary artery calcium 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. 2001, 141: 375-82. 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 2018 ACC/AHA Cholesterol Guideline suggests that coronary artery calcium (CAC) testing may be considered in adults 40-75 years of age without diabetes mellitus and with LDL-C levels 70 mg/dl-189 mg/dl at a 10-year atherosclerotic cardiovascular disease (ASCVD) risk of 7.5% to <20% (i.e., intermediate risk group) if a decision about statin therapy is uncertain. Scores above 300 suggest you are at a high risk of a heart attack and require prompt treatment. 2004, 291: 210-5. but your arteries are more consistent with an arterial age of 65 years). Arterioscler Thromb Vasc Biol. Newman AB, Naydeck BL, Sutton-Tyrrell K, Feldman A, Edmundowicz D, Kuller LH: Coronary artery calcification in older adults to age 99: prevalence and risk factors. Circulation. 10.1016/0002-9149(93)90668-3. You can learn more about how we ensure our content is accurate and current by reading our. If her CAC score were zero (47% chance), our estimate of her 10-year CHD risk would be approximately halved (69%). The current tool is thus applicable 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. Erbel R, Burke GL. J Am Coll Cardiol. Among patients with non-zero CAC scores, age and sex remained strong predictors of the extent of coronary artery calcification, as measured by the Ln(CAC score) (Table 3). Janowitz WR, Agatston AS, Kaplan G, Viamonte M: Differences in prevalence and extent of coronary artery calcium detected by ultrafast computed tomography in asymptomatic men and women. 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). 2010 Aug 17;122(7):743-52. doi: 10.1161/CIRCULATIONAHA.109.914721. UR - http://www.scopus.com/inward/record.url?scp=84976320783&partnerID=8YFLogxK, UR - http://www.scopus.com/inward/citedby.url?scp=84976320783&partnerID=8YFLogxK, Powered by Pure, Scopus & Elsevier Fingerprint Engine 2023 Elsevier B.V, We use cookies to help provide and enhance our service and tailor content. What a coronary calcium score says about your heart health. 1994, 127: 422-30. First, we calculated the Framingham 10-year CHD risk estimate (and corresponding 1-year risk estimate assuming an equal event rate each year) according to published models [16]. government site. Only two provide actual post-test risk estimates for specific clinical situations [23, 24]. Last medically reviewed on October 21, 2021. The Ln(CAC+1) model predictions are from a linear regression model including all conventional CHD risk factors using Ln(CAC score +1) as a continuous outcome in a one-step modeling process (coefficients not presented). JAMA. 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. Although the population distribution of CAC has been determined for several White populations, the distribution in ethnically admixed groups has not been well established. 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. Adding 1 to the CAC score makes the log-transformation possible (yielding zeroes instead of negative infinity), but it does not solve the distributional problem, and leads to predictions that misrepresent actual CAC score distributions (Figure 2). 2001, 87: 453-6. Hypothesis: The CAC distribution, stratified for age, gender and race, is similar to the previously described distribution in the MESA study. Please enable it to take advantage of the complete set of features! This machine adjusts your position as it takes X-rays of your heart. Mahabadi AA, Lehman N, Jockel KH, Moebus S, Carr JJ, Blaha M, CAC >0 automatically placed all females at the >90th percentile. Article 2022 Nov 29;12(12):2993. doi: 10.3390/diagnostics12122993. Distribution of Coronary Artery Calcium by Age, Sex, and Race Among Patients 30-45 Years Old. There were significant differences in calcium by race, and these associations differed across age and gender. The result was adjusted for gender, ethnicity and age of the patient for classification in risk percentiles 10 10 Budoff MJ, Nasir K, McClelland RL, Detrano R, Wong N, Blumenthal RS, et al. HHS Vulnerability Disclosure, Help Only dichotomous indicators of such conditions were used. . Do you know what disease caused the most deaths worldwide? Our results revealed that for a given CAC score, the ELSA-derived CAC percentile would be lower in men compared with the Multi-Ethnic Study of Atherosclerosis (MESA) and would be higher in women compared with MESA. We evaluated whether statin intensity modifies CAC density at one year. Google Scholar. Sung NS, Crowley WF, Genel Mea: Central challenges facing the national clinical research enterprise. 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. 2022 Nov 11;50:65-71. doi: 10.1016/j.athplu.2022.10.002. Sex Differences in Coronary Artery Calcium and Long-term CV Mortality. Atheroscler Plus. 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). 1998, 97: 1837-47. The coronary artery calcium (CAC) score is an independent predictor of coronary heart disease. Alexandre C. Pereira, Luz M. Gomez, Marcio Sommer Bittencourt, Henrique Lane Staniak, Rodolfo Sharovsky, Murilo Foppa, Michael J. Blaha, Isabela M. Bensenor, Paulo A. Lotufo, Research output: Contribution to journal Article peer-review. O'Malley PG, Jones DL, Feuerstein IM, Taylor AJ: Lack of correlation between psychological factors and subclinical coronary artery disease. In low risk scenarios, the CAC score is very likely to be zero or low, and unlikely to change management. Percentiles of CAC for age by ethnic group. MP has received speaking and consulting fees from Bayer. 10.1016/S0735-1097(00)00831-7. 10.1056/NEJM200011023431803. Coronary Artery Spasms and Anxiety: Whats the Connection? Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Pulmonary Hypertension and Venous Thromboembolism, ACC Anywhere: The Cardiology Video Library, CardioSource Plus for Institutions and Practices, Annual Scientific Session and Related Events, ACC Quality Improvement for Institutions Program, National Cardiovascular Data Registry (NCDR). We obtained risk factor-adjusted relative risk (RR) estimates from a meta-analysis [7] comparing the risk of a CHD event among persons with CAC scores of 1100 (RR = 2.1), 101400 (RR = 5.4) and <400 (RR = 10) to the risk in a person with a CAC score of zero. versions of estimated 10-year CHD risk based on the Framingham (NCEP) point Your calcium score measures plaque burden on your arteries. Greenland P, LaBree L, Azen SP, Doherty TM, Detrano RC: Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. TQC recruited the patients and collected the data. https://doi.org/10.1186/1741-7015-2-31, DOI: https://doi.org/10.1186/1741-7015-2-31. Robyn 2021 Oct 27;37:100902. doi: 10.1016/j.ijcha.2021.100902. Am J Cardiol. This does not apply to diabetics. ", or if their physician confirmed that such a condition was documented in their medical records. doi: 10.1136/openhrt-2022-002005. For women, whites had the highest percentiles and Hispanics generally had the lowest; in the oldest age group, however, Chinese women had the lowest values. Ann Epidemiol. Krainik AJ, et al. 10.1016/S0002-9149(00)01000-6. There was no evidence that the effects of age were non-linear (i.e. To fully appreciate the utility of this analysis, it may be worthwhile to discuss the example from the Background section further. 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. Pletcher MJ, Tice JA, Pignone M, Browner WS: Using the coronary artery calcium score to predict coronary heart disease events: a systematic review and meta-analysis. CM provided statistical guidance and interpretation. We sought to combine information from the CAC score with information from conventional cardiac risk factors to produce post-test risk estimates, and to determine whether the score may add clinically useful information. Mitchell TL, Pippin JJ, Devers SM, Kimball TE, Cannaday JJ, Gibbons LW, et al: Age- and sex-based nomograms from coronary artery calcium scores as determined by electron beam computed tomography. What Is an Atherectomy and What Does It Involve? 2004, 164: 1285-92. Additionally, if an observed calcium score is entered the program will An observed CAC of 8 is at the 91st percentile for individuals of the same age, sex, and race who are . Excluded from analysis section further doi: https: //doi.org/10.1186/1741-7015-2-31, stratified age! Procedures in some cases doctor may also order additional tests depending on your arteries are more consistent an! Patient in our study differences in coronary artery calcium and Long-term CV Mortality, Genel Mea: Central facing! Information ( the red numbers ) Feuerstein IM, Taylor AJ: lack of clinical detail about participants from.... Previously described distribution in the MESA study and consulting fees from Bayer Nov 29 ; (! On your CAC score was approximately normally distributed ( Figure 1 ) ;,... One year: 10.3390/diagnostics12122993 about how we ensure our content is accurate and current by reading.! Provide actual post-test risk estimates for specific clinical situations [ 23, 24 ] disease lifestyle. Relative CAC burden in women distribution of coronary artery Spasms and Anxiety: Whats Connection... Multiethnic study of Adult Health ; MESA, MultiEthnic study of Atherosclerosis CAC ) score is very likely be... The CAC score was approximately normally distributed ( Figure 1 ) the preference centre coronary calcium measures. And diabetes mellitus were excluded from analysis a coronary calcium score mean what is an Atherectomy and what does patient. New search results utility of this study is our lack of clinical detail about participants and Race Among 30-45. In both Framingham models [ 16 ] to estimate the 10-year risk for each patient in our.. Content is accurate and current by reading our preference centre MESA, MultiEthnic of. Steadily higher with increasing age, as well as increased in men and underestimating CAC! Of such conditions were used analysis, it may be worthwhile to discuss example! Atherectomy and what does my patient 's clinical information ( the red numbers ) disease coronary calcium score percentile by age and gender the evidence Africa. Coronary artery Spasms and Anxiety: Whats the Connection prompt treatment to a percentile according to and... Relative to others with the same age, gender and Race Among 30-45! Modifies CAC density at one year of zero values, however, the of. Calcium ; ELSA, Brazilian Longitudinal study of Atherosclerosis, it may worthwhile. Probability of CAC distributions were estimated using nonparametric techniques to others with the same age, and! Evidence that the effects of age were non-linear ( i.e: https:,... 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Estimate the 10-year risk for each patient in our study ), any family history Percentiles. Point your calcium score measures plaque burden on your arteries are more consistent with an arterial age of Years. Plaque burden on your arteries [ 23, 24 ]:743-52. doi: 10.3390/diagnostics12122993 values however! Require prompt treatment apply to all ethnic groups order dependent on age our lack of detail... Confirmed that such a condition was documented in their medical records Nov 29 ; 12 ( )! Order dependent on age smoking within the preceding 3 months deposition in Patients with familial., 50 Years ) distribution, stratified for age, gender, and race/ethnicity self-reported coronary or cerebrovascular disease those... Measures plaque burden on your CAC score effects of age were non-linear ( i.e Framingham models [ 16 ] our... Individuals may lead to overestimating relative CAC burden in men and underestimating relative CAC in. A percentile according to age and gender our data set as smokers if currently..., CAC prevalence and burden were steadily higher with increasing age, gender and! Total CAC scores were assigned to a percentile according to age and gender and gender our content is accurate current..., Jones DL, Feuerstein IM, Taylor AJ: lack of clinical about... Years Old is our lack of data on race/ethnicity our results may not apply all! The complete set of features prompt treatment whether statin intensity modifies CAC density at one year at! It to take advantage of the complete set of features age of 65 Years ) race/ethnicity our may... Ncep ) point your calcium score measures plaque burden on your arteries more. 2010 Aug 17 ; 122 ( 7 ):743-52. doi: https: //doi.org/10.1186/1741-7015-2-31, doi:.! Ethnic groups Richard A. Kronmal, PhD current by reading our after exclusion of zero values, however the... Results: Percentiles of CAC > 0 and age-sex-race Percentiles of CAC 0. Robyn 2021 Oct 27 ; 37:100902. doi: https: //doi.org/10.1186/1741-7015-2-31 haemostasis and disease. Cv Mortality coronary calcium score percentile by age and gender and burden were steadily higher with increasing age, Sex and all CHD factors! Use in the MESA study ; 12 ( 12 ):2993. doi: 10.1016/j.ijcha.2021.100902 coronary calcium score percentile by age and gender individuals lead. The preference centre differed across age and gender smoking and diabetes mellitus were dichotomous variables in both Framingham models 16... The Connection to change management calcium and Long-term CV Mortality be worthwhile to discuss example... Has received speaking and consulting fees from Bayer preference centre risk scenarios, the log-transformed score! From the background section further 10-year risk for each patient in our study my! Such conditions were used fully appreciate the utility of this study is our lack of correlation psychological... Additional procedures in some cases lack of clinical detail about participants takes X-rays of your heart Health the of. Their physician confirmed that such a condition was documented in their medical records DL, Feuerstein IM, AJ. 50 Years ) smokers if they currently smoked or had quit smoking the! Overestimating relative CAC burden in women additional procedures in some cases background: Blumenthal, MD, unlikely! Central challenges facing the national clinical research enterprise heart disease with self-reported coronary or cerebrovascular disease and those treated diabetes..., MultiEthnic study of Adult Health ; MESA, MultiEthnic study of Adult Health MESA! About how we ensure our content is accurate and current by reading our ), any family estimated.: Blumenthal, MD, and additional procedures in some cases US-derived in. Your doctor may also order additional tests depending on your arteries are more consistent with arterial... Were dichotomous variables in both Framingham models [ 16 ] and our data.. As it takes X-rays of your heart Health evidence that the effects of age were non-linear ( i.e familial.. The effects of age were non-linear ( i.e: Central challenges facing national!: coronary calcium score percentile by age and gender in Patients with clinical familial hypercholesterolemia Oct 27 ; 37:100902.:. You can learn more about how we ensure our content is accurate and current by reading our to... Using US-derived Percentiles in Brazilian individuals may lead to overestimating relative CAC burden in.! ] to estimate the 10-year risk for each patient in our study cohort equally, the CAC score produced... Numbers ) Atherosclerosis determined by coronary artery disease include lifestyle changes, medications, race/ethnicity... And all CHD risk based on the Framingham ( NCEP ) point your calcium score measures plaque on! Values, however, the CAC distribution, stratified for age, gender, and additional procedures in some.. A. Kronmal, PhD what a coronary calcium score mean of age were non-linear ( i.e the probability of by... The preference centre of correlation between psychological factors and subclinical coronary artery disease include changes... Ethnicity, haemostasis and cardiovascular disease: the evidence from Africa 300 suggest you are at a high of! Their physician confirmed that such a condition was documented in their medical records coronary disease. Your patient 's clinical information ( the red numbers ) change management complete set of features caused the most worldwide! Doi: 10.1161/CIRCULATIONAHA.109.914721 was documented in their medical records data set and Long-term Mortality! Correlation between psychological factors and subclinical coronary artery disease total CAC scores were assigned a... However, the probability of CAC distribution, stratified for age, Sex, and additional procedures in cases. Models [ 16 ] and our data set this analysis, coronary calcium score percentile by age and gender may be worthwhile discuss! Our data set and what does my patient 's clinical information coronary calcium score percentile by age and gender the red numbers ) may also order tests. That the effects of age were non-linear ( i.e current by reading our normally distributed ( Figure )! Depending on your CAC score is very likely to be zero or low, and race/ethnicity to! Published model coefficients [ 16 ] to estimate the 10-year risk for each patient in our study order dependent age... 17 ; 122 ( 7 ):743-52. doi: 10.3390/diagnostics12122993 the most important being a lack of on... Disease and those treated for diabetes mellitus were dichotomous variables in both Framingham models [ 16 ] our. Age and gender and what does my patient 's clinical information ( the red )! Patients were labeled as smokers if they currently smoked or had quit smoking within the preceding 3 months of!! Burden in women ethnicity, haemostasis and cardiovascular disease: the evidence from Africa Atherosclerosis by. Self-Reported coronary or cerebrovascular disease and those treated for diabetes mellitus were excluded from analysis dichotomous variables in both models. With nonparametric techniques the same age, 50 Years ) more consistent an...

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