From the Guidelines
Atherosclerosis of the aorta detected incidentally on chest X-ray or CT scan without symptoms is considered a form of subclinical atherosclerotic cardiovascular disease (ASCVD), but not necessarily clinical ASCVD as defined by the AHA/ACC guidelines. This finding represents evidence of atherosclerotic plaque buildup in the arterial wall, even in the absence of clinical symptoms. The presence of aortic calcification or plaque on imaging studies indicates that the atherosclerotic disease process is already underway, which places the individual at higher risk for future cardiovascular events such as heart attack or stroke 1. According to the ESC/EAS guidelines, unequivocally documented ASCVD on imaging, including significant plaque on coronary angiography or CT angiography, is considered very high risk, but the AHA/ACC guidelines do not include nonclinical ASCVD in the high-risk cohort 1.
Key Considerations
- The AHA/ACC guidelines acknowledge the use of coronary artery calcium (CAC) score as a risk modifier in low- or moderate-risk patients, and consider CAC score >100 as an indicator of high risk 1.
- The ESC/EAS guidelines recommend arterial plaque burden on ultrasonography as a risk modifier in individuals at low or moderate risk, and consider carotid or femoral plaque burden as a risk enhancer 1.
- Management of incidental atherosclerosis typically includes lifestyle modifications (diet, exercise, smoking cessation) and consideration of preventive medications such as statins based on overall risk profile, with the intensity of statin therapy depending on the patient's age, comorbidities, and calculated 10-year ASCVD risk score 1.
Implications for Practice
- Incidental findings of atherosclerosis on imaging studies should prompt a comprehensive cardiovascular risk assessment, including evaluation of other risk factors like hypertension, diabetes, smoking, and lipid abnormalities.
- The presence of aortic calcification or plaque on imaging studies indicates a need for preventive measures to reduce the risk of future cardiovascular events.
- Clinicians should consider the latest guidelines and individual patient factors when determining the best course of management for incidental atherosclerosis.
From the Research
Definition of ASCVD
Atherosclerotic cardiovascular disease (ASCVD) refers to a group of conditions caused by the buildup of plaque in the arteries, leading to cardiovascular events such as heart attacks, strokes, and peripheral artery disease.
Detection of Atherosclerosis on Chest X-ray or CT Scan
- Atherosclerosis of the aorta detected incidentally on chest X-ray or CT scan without symptoms can be an indicator of ASCVD, as it suggests the presence of atherosclerotic lesions in the aorta or its major branches 2.
- Studies have shown that incidentally detected atherosclerotic lesions in the abdominal aorta or its major branches on computed tomography are highly associated with coronary heart disease in asymptomatic adults 2.
- The presence of atherosclerotic lesions in the aorta or its major branches can be detected using various imaging modalities, including CT scans, MRI, and ultrasound 3, 4.
- Coronary artery calcification (CAC) is a marker of atherosclerosis and an independent risk factor for cardiac-related mortality, and can be identified on routine chest CT scans 5.
Clinical Implications
- The detection of atherosclerosis on chest X-ray or CT scan without symptoms can have significant clinical implications, including the need for further evaluation and management of cardiovascular risk factors 2, 5.
- The presence of aortic valve calcification on CT scans can be a marker for clinically significant aortic stenosis, particularly in patients younger than 55 years old and those with moderately dense aortic valve calcification 6.
- The extent of arterial territory involvement can be associated with the presence of significant coronary stenoses, and the detection of atherosclerotic lesions in the aorta or its major branches can add predictive value to significant coronary stenosis 2.