Extra-coronary Calcification and Cardiovascular Events: What Do We Know and Where Are We Heading?

Dixitha Anugula, Rhanderson Cardoso, Gowtham R. Grandhi, Ron Blankstein, Khurram Nasir, Mouaz Al-Mallah, Dipan J. Shah, Miguel Cainzos-Achirica

Research output: Contribution to journalReview articlepeer-review

3 Scopus citations


PURPOSE OF REVIEW: The coronary artery calcium score is a guideline-endorsed aid for further risk stratification in the primary prevention of atherosclerotic cardiovascular disease. The non-contrast scan performed for detection of coronary artery calcium also gives an opportunity to visualize calcifications in the thoracic aorta and in the heart valves, at no additional cost or radiation exposure. The purpose of this review was to discuss the potential clinical value of measuring thoracic aortic calcification, aortic valve calcification, and mitral annulus calcification.

RECENT FINDINGS: After two decades of active research, all three calcifications have been extensively evaluated, across various cohorts. We discuss classic and recent studies, current knowledge gaps, and future directions in this space. The added value of these measurements has traditionally been considered modest at best, and they are not currently discussed in relevant primary prevention guidelines in North America and Europe. However, recent studies evaluating high thoracic calcification thresholds and younger populations have further enriched this space. Specifically, some studies suggest that detection of severe thoracic aortic calcification may be helpful in further risk assessment and that detection of aortic valve calcifications may have important prognostic implications in younger individuals. Although more research is needed, particularly in larger young-to-middle-aged cohorts, future guidelines might consider including these features as risk-enhancing factors.

Original languageEnglish (US)
Pages (from-to)755-766
Number of pages12
JournalCurrent Atherosclerosis Reports
StatePublished - Oct 2022


  • Calcifications
  • Cardiovascular disease
  • Computed tomography
  • Imaging
  • Primary prevention
  • Risk assessment
  • Calcium
  • Humans
  • Middle Aged
  • Risk Factors
  • Aortic Valve Stenosis
  • Coronary Artery Disease/diagnostic imaging
  • Vascular Calcification/diagnostic imaging
  • Calcinosis/diagnostic imaging
  • Aortic Valve/diagnostic imaging

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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