From the Guidelines
A calcium CT scan is recommended for asymptomatic patients at intermediate risk for coronary artery disease, as it provides valuable information on calcium deposits in the coronary arteries and helps guide preventive strategies. The test is non-invasive, takes about 10-15 minutes, and involves minimal radiation exposure 1. The results are reported as a calcium score, with zero indicating no detectable calcium (lowest risk), 1-100 suggesting mild calcification, 101-400 moderate calcification, and over 400 extensive calcification (highest risk) 1. Some key points to consider when interpreting the results include:
- A calcium score of >100 is predictive of coronary heart disease, with a 2.2 times higher risk for all-cause mortality, 4.3 times higher cardiovascular specific mortality, and 10.4 times higher risk of coronary heart disease, than patients with a zero calcium score 1.
- The presence of any CAC (>0) is associated with an increased risk of major adverse cardiovascular events (MACE), even in young individuals without traditional risk factors 1.
- Higher scores correlate with greater risk of future cardiac events, with relative adjusted subhazard ratios for CAC 1 to 100,101 to 400, and >400 being 2.2,3.8, and 5.9 for myocardial infarction, respectively 1. The calcium score provides valuable information beyond traditional risk factors by directly visualizing atherosclerotic plaque burden, allowing for more personalized cardiovascular risk assessment and management 1. It is essential to note that insurance coverage varies, so checking with your provider beforehand is advisable. In clinical practice, the decision to perform a calcium CT scan should be based on individual patient risk factors and medical history, with the goal of reducing morbidity, mortality, and improving quality of life 1.
From the Research
Calcium CT Scans
- Calcium CT scans are used to detect coronary artery calcium (CAC) which is a validated risk marker of major adverse cardiovascular events (MACE) 2.
- The presence of CAC on non-gated CT chest scans can be used to guide the initiation of statin therapy in primary prevention 3.
- Reporting of CAC in the final impression of non-gated CT chest scans increases the appropriate utilization of statins 2.
Coronary Artery Calcium Scoring
- Coronary artery calcium scoring is a strongly predictive marker of adverse coronary artery disease events 4.
- The Agatston score is used to quantify coronary artery calcification on gated calcium score CTs 4.
- Ordinal scoring on non-gated chest CTs can be used to estimate coronary calcium burden and correlates with Agatston score on gated calcium score CTs 4.
Lipid-Lowering Therapy
- Lipid-lowering therapy using atorvastatin can lead to a significant reduction in noncalcified plaque burden 5.
- Statin therapy can reduce the risk of major adverse cardiovascular events (MACE) by reducing noncalcified plaque burden 5.
- The effect of lipid-lowering therapy on calcified and noncalcified coronary plaques can be monitored using multislice detector computed tomography 5.
Calcium Supplementation
- Calcium supplementation can be beneficial for bone health in children, young adults, and menopausal women 6.
- Calcium from carbonate and citrate are the most common forms of calcium supplements, with calcium carbonate being the most cost-effective form 6.
- The maximum dose of elemental calcium that should be taken at a time is 500 mg 6.