TY - JOUR
T1 - Role of coronary artery calcium score in the primary prevention of cardiovascular disease
AU - Nasir, Khurram
AU - Cainzos-Achirica, Miguel
N1 - Funding Information:
on declaration of interests and declare the following interests: Khurram Nasir is on the advisory board of Amgen, Novartis, Medicine Company, and his research is partly supported by the Jerold B. Katz Academy of Translational Research. Miguel Cainzos-Achirica is fully supported by the Jerold B Katz Academy of Translational Research and has no other disclosures to report.
Funding Information:
Khurram Nasir is on the advisory board of Amgen, Novartis, Medicine Company, and his research is partly supported by the Jerold B. Katz Academy of Translational Research. Miguel Cainzos-Achirica is fully supported by the Jerold B Katz Academy of Translational Research and has no other disclosures to report.
Publisher Copyright:
© Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/5/4
Y1 - 2021/5/4
N2 - First developed in 1990, the Agatston coronary artery calcium (CAC) score is an international guideline-endorsed decision aid for further risk assessment and personalized management in the primary prevention of atherosclerotic cardiovascular disease. This review discusses key international studies that have informed this 30 year journey, from an initial coronary plaque screening paradigm to its current role informing personalized shared decision making. Special attention is paid to the prognostic value of a CAC score of zero (the so called "power of zero"), which, in a context of low estimated risk thresholds for the consideration of preventive therapy with statins in current guidelines, may be used to de-risk individuals and thereby inform the safe delay or avoidance of certain preventive therapies. We also evaluate current recommendations for CAC scoring in clinical practice guidelines around the world, and past and prevailing barriers for its use in routine patient care. Finally, we discuss emerging approaches in this field, with a focus on the potential role of CAC informing not only the personalized allocation of statins and aspirin in the general population, but also of other risk-reduction therapies in special populations, such as individuals with diabetes and people with severe hypercholesterolemia.
AB - First developed in 1990, the Agatston coronary artery calcium (CAC) score is an international guideline-endorsed decision aid for further risk assessment and personalized management in the primary prevention of atherosclerotic cardiovascular disease. This review discusses key international studies that have informed this 30 year journey, from an initial coronary plaque screening paradigm to its current role informing personalized shared decision making. Special attention is paid to the prognostic value of a CAC score of zero (the so called "power of zero"), which, in a context of low estimated risk thresholds for the consideration of preventive therapy with statins in current guidelines, may be used to de-risk individuals and thereby inform the safe delay or avoidance of certain preventive therapies. We also evaluate current recommendations for CAC scoring in clinical practice guidelines around the world, and past and prevailing barriers for its use in routine patient care. Finally, we discuss emerging approaches in this field, with a focus on the potential role of CAC informing not only the personalized allocation of statins and aspirin in the general population, but also of other risk-reduction therapies in special populations, such as individuals with diabetes and people with severe hypercholesterolemia.
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U2 - 10.1136/bmj.n776
DO - 10.1136/bmj.n776
M3 - Review article
C2 - 33947652
SN - 0959-8146
VL - 373
SP - n776
JO - BMJ
JF - BMJ
M1 - n776
ER -