What is the significance of a coronary calcium score of mild calcification?

From the Guidelines

A coronary calcium score indicating mild calcification is a significant finding that warrants attention and potential intervention to reduce the risk of cardiovascular events, as it is associated with an increased risk of heart disease and mortality, as shown in a study by Shaw et al 1. The presence of any measurable coronary calcium is independently related to hard and soft events in men and women at low to intermediate pretest risk, providing incremental prognostic information over conventional risk factors 1. Some key points to consider with a mild coronary calcium score include:

• The score falls within the range of 1-100, which is considered mild plaque buildup in the coronary arteries
• This level of calcification represents a slightly elevated risk for heart disease compared to someone with a score of zero
• The calcium score measures calcium deposits in the coronary arteries, which develop as part of atherosclerotic plaque formation
• These plaques can eventually narrow arteries or rupture, potentially causing heart attacks
• Early detection and management are important even with mild calcification, as shown in a study by Budoff et al 1, which demonstrated incremental risk beyond age, gender, ethnicity, and cardiac risk factors. It is essential to discuss the result with a healthcare provider, who may recommend lifestyle modifications and potential preventive medications, such as low-dose aspirin or statins, depending on other risk factors, as suggested by the AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline 1. The healthcare provider may also consider the patient's overall risk profile, including age, family history, cholesterol levels, blood pressure, and diabetes status, to determine the best course of action, as recommended by the 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults 1. In terms of management, a study by Polonsky et al 1 showed that the net reclassification index was 25% when using the CAC score in conjunction with conventional risk factors, indicating that the CAC score can help reclassify patients into higher or lower risk categories. Overall, a mild coronary calcium score is a significant finding that requires attention and potential intervention to reduce the risk of cardiovascular events, and patients should work with their healthcare provider to develop a personalized plan to manage their risk, as supported by the highest quality evidence from Shaw et al 1.

From the Research

Coronary Calcium Score Significance

The significance of a coronary calcium score of mild calcification can be understood by considering the following points:

• A coronary calcium score is a measure of the amount of calcium in the coronary arteries, which is a marker of atherosclerosis 2.
• A score of 0 indicates that a cardiovascular event is extremely unlikely in the next 5 years, while a score greater than 0 portends a coronary event 3.
• The higher the score, the greater the risk of a cardiovascular event 3.

Risk Stratification

Coronary calcium scoring is useful as a risk-stratification tool in coronary artery disease 2.

• A score of 400 or higher is a reliable, noninvasive predictor of the progression of coronary artery diseases and their consequences, including major adverse cardiovascular events (MACE) 2.
• The coronary calcium score improves CAD risk prediction, compared to conventional risk scoring, even in the absence of cardiovascular risk factor inputs 4.

Predictors of Coronary Artery Calcification

The following lipid parameters are good predictors of presence of coronary artery calcification:

• Total cholesterol/high-density lipoprotein cholesterol (TC/HDL-C) ratio 5.
• Low-density lipoprotein cholesterol/high-density lipoprotein cholesterol (LDL/HDL-C) ratio 5.
• A cut-off value of ≥ 3.108 for LDL/HDL ratio shows a sensitivity of 58.8% and specificity of 84.6% in prediction of coronary calcium 5.
• A cut-off value of ≥ 4.742 for TC/HDL ratio shows a sensitivity of 60.3% and specificity of 88.5% in prediction of coronary calcium 5.

Impact of Lipid-Lowering Therapies

Lipid-lowering therapies have a significant impact on cardiovascular outcomes according to coronary artery calcium score 6.

• A CAC score > 100 identifies individuals most likely to benefit from lipid-lowering therapy, while undetectable CAC suggests no treatment benefit 6.
• Lipid-lowering therapy is associated with reduced occurrence of ASCVD in patients with CAC > 100 6.