J Cardiovasc Ultrasound.  2015 Dec;23(4):195-203. 10.4250/jcu.2015.23.4.195.

Reassessing the Usefulness of Coronary Artery Calcium Score among Varying Racial and Ethnic Groups by Geographic Locations: Relevance of the Korea Initiatives on Coronary Artery Calcification Registry

Affiliations
  • 1Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University Health System, Seoul, Korea. hjchang@yuhs.ac
  • 2Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA.
  • 3Division of Cardiology, Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea.
  • 4Division of Cardiology, Heart Stroke & Vascular Institute, Samsung Medical Center, Seoul, Korea.

Abstract

There is some disparity in the morbidity and mortality rates of cardiovascular disease (CVD) according to race, ethnicity, and geographic regions. Although prediction algorithms that evaluate risk of cardiovascular events have been established using traditional risk factors, they have also demonstrated a number of differences along with race and ethnicity. Of various risk assessment modalities, coronary artery calcium (CAC) score is a sensitive marker of calcific atherosclerosis and correlates well with atherosclerotic plaque burden. Although CAC score is now utilized as a useful tool for early detection of coronary artery disease, prior studies have suggested some variability in the presence and severity of coronary calcification according to race, ethnicity, and/or geographic regions. Among Asian populations, it would appear necessary to reappraise the utility of CAC score and whether it remains superior over and above established clinical risk prediction algorithms. To this end, the Korea initiatives on coronary artery calcification (KOICA) registry has been designed to identify the effectiveness of CAC score for primary prevention of CVD in asymptomatic Korean adults. This review discusses the important role of CAC score for prognostication, while also describing the design and rationale of the KOICA registry.

Keyword

Cardiovascular disease; Coronary artery calcium score; Coronary artery disease; Risk prediction algorithm; Ethnicity

MeSH Terms

Adult
Asian Continental Ancestry Group
Atherosclerosis
Calcium*
Cardiovascular Diseases
Continental Population Groups
Coronary Artery Disease
Coronary Vessels*
Ethnic Groups*
Geographic Locations*
Humans
Korea*
Mortality
Plaque, Atherosclerotic
Primary Prevention
Risk Assessment
Risk Factors
Calcium

Figure

  • Fig. 1 Age-adjusted death rates of CAD and CVD according to race/ethnicity. CAD: coronary artery disease, CVD: cardiovascular disease.


Cited by  1 articles

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Wonjae Lee, Yeonyee E. Yoon, Ohkyung Kwon, Heesun Lee, Hyo Eun Park, Eun Ju Chun, Su-Yeon Choi, Goo-Yeong Cho, Hyuk-Jae Chang
Korean Circ J. 2019;49(5):448-457.    doi: 10.4070/kcj.2018.0318.


Reference

1. Who.int [Internet].Cardiovascular diseases (CVDs). Geneva: World Health Organization;updated 2015 Jan. cited 2015 Sep 1. Available from: http://www.who.int/mediacentre/factsheets/fs317/en/.
2. Zhang XH, Lu ZL, Liu L. Coronary heart disease in China. Heart. 2008; 94:1126–1131.
3. Meadows TA, Bhatt DL, Cannon CP, Gersh BJ, Röther J, Goto S, Liau CS, Wilson PW, Salette G, Smith SC, Steg PG. REACH Registry Investigators. Ethnic differences in cardiovascular risks and mortality in atherothrombotic disease: insights from the Reduction of Atherothrombosis for Continued Health (REACH) registry. Mayo Clin Proc. 2011; 86:960–967.
4. Ueshima H, Sekikawa A, Miura K, Turin TC, Takashima N, Kita Y, Watanabe M, Kadota A, Okuda N, Kadowaki T, Nakamura Y, Okamura T. Cardiovascular disease and risk factors in Asia: a selected review. Circulation. 2008; 118:2702–2709.
5. Tunstall-Pedoe H, Kuulasmaa K, Amouyel P, Arveiler D, Rajakangas AM, Pajak A. Myocardial infarction and coronary deaths in the World Health Organization MONICA Project. Registration procedures, event rates, and case-fatality rates in 38 populations from 21 countries in four continents. Circulation. 1994; 90:583–612.
6. Thorvaldsen P, Asplund K, Kuulasmaa K, Rajakangas AM, Schroll M. Stroke incidence, case fatality, and mortality in the WHO MONICA project. World Health Organization Monitoring Trends and Determinants in Cardiovascular Disease. Stroke. 1995; 26:361–367.
7. Liu J, Hong Y, D'Agostino RB Sr, Wu Z, Wang W, Sun J, Wilson PW, Kannel WB, Zhao D. Predictive value for the Chinese population of the Framingham CHD risk assessment tool compared with the Chinese Multi-Provincial Cohort Study. JAMA. 2004; 291:2591–2599.
8. D'Agostino RB Sr, Grundy S, Sullivan LM, Wilson P. CHD Risk Prediction Group. Validation of the Framingham coronary heart disease prediction scores: results of a multiple ethnic groups investigation. JAMA. 2001; 286:180–187.
9. Hense HW, Schulte H, Löwel H, Assmann G, Keil U. Framingham risk function overestimates risk of coronary heart disease in men and women from Germany--results from the MONICA Augsburg and the PROCAM cohorts. Eur Heart J. 2003; 24:937–945.
10. Marrugat J, Solanas P, D'Agostino R, Sullivan L, Ordovas J, Cordón F, Ramos R, Sala J, Masià R, Rohlfs I, Elosua R, Kannel WB. [Coronary risk estimation in Spain using a calibrated Framingham function]. Rev Esp Cardiol. 2003; 56:253–261.
11. Vergnaud AC, Bertrais S, Galan P, Hercberg S, Czernichow S. Tenyear risk prediction in French men using the Framingham coronary score: results from the national SU.VI.MAX cohort. Prev Med. 2008; 47:61–65.
12. Ferrario M, Chiodini P, Chambless LE, Cesana G, Vanuzzo D, Panico S, Sega R, Pilotto L, Palmieri L, Giampaoli S. CUORE Project Research Group. Prediction of coronary events in a low incidence population. Assessing accuracy of the CUORE Cohort Study prediction equation. Int J Epidemiol. 2005; 34:413–421.
13. Jee SH, Jang Y, Oh DJ, Oh BH, Lee SH, Park SW, Seung KB, Mok Y, Jung KJ, Kimm H, Yun YD, Baek SJ, Lee DC, Choi SH, Kim MJ, Sung J, Cho B, Kim ES, Yu BY, Lee TY, Kim JS, Lee YJ, Oh JK, Kim SH, Park JK, Koh SB, Park SB, Lee SY, Yoo CI, Kim MC, Kim HK, Park JS, Kim HC, Lee GJ, Woodward M. A coronary heart disease prediction model: the Korean Heart Study. BMJ Open. 2014; 4:e005025.
14. Goff DC Jr, Lloyd-Jones DM, Bennett G, Coady S, D'Agostino RB, Gibbons R, Greenland P, Lackland DT, Levy D, O'Donnell CJ, Robinson JG, Schwartz JS, Shero ST, Smith SC Jr, Sorlie P, Stone NJ, Wilson PW, Jordan HS, Nevo L, Wnek J, Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH, DeMets D, Hochman JS, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW, Shen WK, Smith SC Jr, Tomaselli GF. American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014; 129:25 Suppl 2. S49–S73.
15. Bild DE, Detrano R, Peterson D, Guerci A, Liu K, Shahar E, Ouyang P, Jackson S, Saad MF. Ethnic differences in coronary calcification: the Multi-Ethnic Study of Atherosclerosis (MESA). Circulation. 2005; 111:1313–1320.
16. Budoff MJ, Nasir K, Mao S, Tseng PH, Chau A, Liu ST, Flores F, Blumenthal RS. Ethnic differences of the presence and severity of coronary atherosclerosis. Atherosclerosis. 2006; 187:343–350.
17. Tang W, Detrano RC, Brezden OS, Georgiou D, French WJ, Wong ND, Doherty TM, Brundage BH. Racial differences in coronary calcium prevalence among high-risk adults. Am J Cardiol. 1995; 75:1088–1091.
18. Hatwalkar A, Agrawal N, Reiss DS, Budoff MJ. Comparison of prevalence and severity of coronary calcium determined by electron beam tomography among various ethnic groups. Am J Cardiol. 2003; 91:1225–1227.
19. World Health Organization. Global atlas on cardiovascular disease prevention and control [Internet]. Geneva: World Health Organization;2011. cited 2015 Sep 1. Available from: http://www.who.int/cardiovascular_diseases/publications/atlas_cvd/en/.
20. Arizonahealthmatters.org [Internet]. Age-adjusted death rate due to coronary heart disease. Arizona: Arizona Health Matters;updated 2015 Jan. cited 2015 Sep 1. Available from: http://www.arizonahealthmatters.org/modules.php?op=modload±name=NS-Indicator±file=indicator±iid=17274946.
21. Lewey J, Choudhry NK. The current state of ethnic and racial disparities in cardiovascular care: lessons from the past and opportunities for the future. Curr Cardiol Rep. 2014; 16:530.
22. Cooper R, Cutler J, Desvigne-Nickens P, Fortmann SP, Friedman L, Havlik R, Hogelin G, Marler J, McGovern P, Morosco G, Mosca L, Pearson T, Stamler J, Stryer D, Thom T. Trends and disparities in coronary heart disease, stroke, and other cardiovascular diseases in the United States: findings of the national conference on cardiovascular disease prevention. Circulation. 2000; 102:3137–3147.
23. Nhlbi.nih.gov [Internet]. 4. Disease Statistics. Maryland: National Heart, Lung, and Blood Institute;updated 2012. cited 2015 Sep 1. Available from: http://www.worldpopulationstatistics.com/asia-population-2013/.
24. Worldpopulationstatistics.com [Internet]. World Population Statistics. Asia Population 2013;updated 2013 May 20. cited 2015 Sep 1. Available from: http://www.worldpopulationstatistics.com/asia-population-2013/.
25. Korea National Statistical Office. Cause of death statistics in 1983-2013. Daejeon: Korea National Statistical Office;2014.
26. Hutchinson RG, Watson RL, Davis CE, Barnes R, Brown S, Romm F, Spencer JM, Tyroler HA, Wu K. Racial differences in risk factors for atherosclerosis. The ARIC Study. Atherosclerosis Risk in Communities. Angiology. 1997; 48:279–290.
27. Ibrahim SA, Whittle J, Bean-Mayberry B, Kelley ME, Good C, Conigliaro J. Racial/ethnic variations in physician recommendations for cardiac revascularization. Am J Public Health. 2003; 93:1689–1693.
28. Fuster V, Moreno PR, Fayad ZA, Corti R, Badimon JJ. Atherothrombosis and high-risk plaque: part I: evolving concepts. J Am Coll Cardiol. 2005; 46:937–954.
29. Nasir K, Shaw LJ, Liu ST, Weinstein SR, Mosler TR, Flores PR, Flores FR, Raggi P, Berman DS, Blumenthal RS, Budoff MJ. Ethnic differences in the prognostic value of coronary artery calcification for all-cause mortality. J Am Coll Cardiol. 2007; 50:953–960.
30. Wijeysundera HC, Machado M, Farahati F, Wang X, Witteman W, van der Velde G, Tu JV, Lee DS, Goodman SG, Petrella R, O'Flaherty M, Krahn M, Capewell S. Association of temporal trends in risk factors and treatment uptake with coronary heart disease mortality, 1994-2005. JAMA. 2010; 303:1841–1847.
31. Hong Y. Burden of cardiovascular disease in Asia: big challenges and ample opportunities for action and making a difference. Clin Chem. 2009; 55:1450–1452.
32. Choi EK, Choi SI, Rivera JJ, Nasir K, Chang SA, Chun EJ, Kim HK, Choi DJ, Blumenthal RS, Chang HJ. Coronary computed tomography angiography as a screening tool for the detection of occult coronary artery disease in asymptomatic individuals. J Am Coll Cardiol. 2008; 52:357–365.
33. Kannel WB, McGee D, Gordon T. A general cardiovascular risk profile: the Framingham Study. Am J Cardiol. 1976; 38:46–51.
34. Wilson PW, D'Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of coronary heart disease using risk factor categories. Circulation. 1998; 97:1837–1847.
35. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002; 106:3143–3421.
36. Sangiorgi G, Rumberger JA, Severson A, Edwards WD, Gregoire J, Fitzpatrick LA, Schwartz RS. Arterial calcification and not lumen stenosis is highly correlated with atherosclerotic plaque burden in humans: a histologic study of 723 coronary artery segments using nondecalcifying methodology. J Am Coll Cardiol. 1998; 31:126–133.
37. Hecht HS. Coronary artery calcium: utilization for primary prevention of CHD. Curr Cardiol Rep. 2011; 13:465–474.
38. Shaw LJ, Raggi P, Schisterman E, Berman DS, Callister TQ. Prognostic value of cardiac risk factors and coronary artery calcium screening for allcause mortality. Radiology. 2003; 228:826–833.
39. Blaha MJ, Silverman MG, Budoff MJ. Is there a role for coronary artery calcium scoring for management of asymptomatic patients at risk for coronary artery disease?: Clinical risk scores are not sufficient to define primary prevention treatment strategies among asymptomatic patients. Circ Cardiovasc Imaging. 2014; 7:398–408. discussion 408
40. Greenland P, LaBree L, Azen SP, Doherty TM, Detrano RC. Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. JAMA. 2004; 291:210–215.
41. Yeboah J, McClelland RL, Polonsky TS, Burke GL, Sibley CT, O'Leary D, Carr JJ, Goff DC, Greenland P, Herrington DM. Comparison of novel risk markers for improvement in cardiovascular risk assessment in intermediate-risk individuals. JAMA. 2012; 308:788–795.
42. Fujiyoshi A, Miura K, Ohkubo T, Kadowaki T, Kadowaki S, Zaid M, Hisamatsu T, Sekikawa A, Budoff MJ, Liu K, Ueshima H. SESSA Research Group; MESA Research Group. Cross-sectional comparison of coronary artery calcium scores between Caucasian men in the United States and Japanese men in Japan: the multi-ethnic study of atherosclerosis and the Shiga epidemiological study of subclinical atherosclerosis. Am J Epidemiol. 2014; 180:590–598.
43. Park HE, Chun EJ, Choi SI, Lee SP, Yoon CH, Kim HK, Youn TJ, Kim YJ, Choi DJ, Sohn DW, Cho GY. Clinical and imaging parameters to predict cardiovascular outcome in asymptomatic subjects. Int J Cardiovasc Imaging. 2013; 29:1595–1602.
44. Kim BJ, Kim BS, Kang JH. Conventional versus image-based cardiovascular risk assessment in Korean adults. Coron Artery Dis. 2014; 25:118–124.
45. Sung J, Lim SJ, Choe Y, Choi YH, Lee MK, Lee SH, Hong KP, Park JE. Comparison of the coronary calcium score with the estimated coronary risk. Coron Artery Dis. 2008; 19:475–479.
46. Itani Y, Sone S, Nakayama T, Suzuki T, Watanabe S, Ito K, Takashima S, Fushimi H, Sanada H. Coronary artery calcification detected by a mobile helical computed tomography unit and future cardiovascular death: 4-year follow-up of 6120 asymptomatic Japanese. Heart Vessels. 2004; 19:161–163.
47. Fujimoto S, Kondo T, Kumamaru KK, Shinozaki T, Takamura K, Kawaguchi Y, Matsumori R, Hiki M, Miyauchi K, Daida H, Rybicki FJ. Prognostic Value of Coronary Computed Tomography (CT) Angiography and Coronary Artery Calcium Score Performed Before Revascularization. J Am Heart Assoc. 2015; 4:e002264.
48. Yamamoto H, Ohashi N, Ishibashi K, Utsunomiya H, Kunita E, Oka T, Horiguchi J, Kihara Y. Coronary calcium score as a predictor for coronary artery disease and cardiac events in Japanese high-risk patients. Circ J. 2011; 75:2424–2431.
49. Lloyd-Jones DM, Martin DO, Larson MG, Levy D. Accuracy of death certificates for coding coronary heart disease as the cause of death. Ann Intern Med. 1998; 129:1020–1026.
50. Lauer MS, Blackstone EH, Young JB, Topol EJ. Cause of death in clinical research: time for a reassessment? J Am Coll Cardiol. 1999; 34:618–620.
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