Added value of CAC in risk stratification for cardiovascular events: a systematic review
Article first published online: 6 JUN 2011
© 2011 The Authors. European Journal of Clinical Investigation © 2011 Stichting European Society for Clinical Investigation Journal Foundation
European Journal of Clinical Investigation
Volume 42, Issue 1, pages 110–116, January 2012
How to Cite
Peters, S. A. E., Bakker, M., den Ruijter, H. M. and Bots, M. L. (2012), Added value of CAC in risk stratification for cardiovascular events: a systematic review. European Journal of Clinical Investigation, 42: 110–116. doi: 10.1111/j.1365-2362.2011.02555.x
- Issue published online: 7 DEC 2011
- Article first published online: 6 JUN 2011
- Accepted manuscript online: 19 MAY 2011 12:39AM EST
- Received 15 February 2011; accepted 16 May 2011
- Cardiovascular disease;
- coronary artery calcification;
- risk prediction;
- systematic review
Eur J Clin Invest 2012; 42 (1): 110–116
Background Identification of individuals at high risk for cardiovascular disease (CVD) is important to initiate adequate treatment and to prevent future events. Moreover, identification of low-risk individuals is important to refrain from unneeded therapy. Current risk prediction models do not accurately predict the risk of CVD in individuals, and new markers have been sought to improve the risk assessment in individuals. Coronary artery calcification (CAC) is a marker of atherosclerosis that might improve current risk assessment when added to traditional risk factors.
Materials and methods We performed a systematic review on PubMed search (1 February 2011) on studies reporting on the added value of CAC in risk prediction in asymptomatic individuals.
Results Of 39 publications on CAC and CVD, nine studies were carried out in asymptomatic individuals. All studies showed an increase in area under the curve ranging from 0·05 to 0·20 when CAC was added to the risk model. Four studies reported on improvements of individuals in low-, intermediate-, and high-risk categories. Addition of CAC to the risk model resulted in a net reclassification improvement ranging from 14% to 30%, meaning that CAC measurement reclassified a substantial proportion of individuals into correct risk categories. This improvement was most pronounced in those at intermediate Framingham risk.
Conclusions The available studies consistently showed that CAC scoring improves risk stratification in CVD risk categories when added to traditional risk factors only, especially among individuals at intermediate risk for CVD. Cost-effectiveness analyses together with a randomized controlled trial are needed before widespread introduction of CAC in clinical care.