Korean Circ J.  2019 May;49(5):448-457. 10.4070/kcj.2018.0318.

Evaluation of Coronary Artery Calcium Progression in Asymptomatic Individuals with an Initial Score of Zero

• Lee W
• Yoon YE
• Kwon O
• Lee H
• Park HE
• Chun EJ
• Choi SY
• Cho GY
• Chang HJ

• KMID: 2444965
• DOI: http://doi.org/10.4070/kcj.2018.0318

Abstract

BACKGROUND AND OBJECTIVES
Coronary artery calcium (CAC) scoring in the asymptomatic population can improve cardiovascular risk prediction. We aimed to assess CAC progression and the impact of coronary risk factors on the CAC progression rate in asymptomatic Korean individuals with a baseline CAC score of zero.
METHODS
The study population was derived from the Korea Initiatives on Coronary Artery Calcification (KOICA) registry: a retrospective, single ethnicity, multicenter registry of asymptomatic individuals who underwent CAC scoring as a part of a health checkup. Individuals with at least two CAC scores and an initial score of zero were included. CAC progression was defined as [√CAC score (follow-up) −√CAC score (baseline)] ≥2.5. The 10-year atherosclerotic cardiovascular disease (ASCVD) risk was calculated.
RESULTS
Among 6,268 participants (mean age, 48.0±7.1 years; male, 80.5%), 719 (11.5%) experienced CAC progression during follow-up (median, 109 months; interquartile range, 78-208 months). The CAC progression rate was 0.3%, 1.9%, 4.3%, 8.6%, and 16.7% in years 1-5, respectively. The chance of CAC progression at 5 years was 13.1%, 22.0%, and 27.9% for individuals with a 10-year ASCVD risk of <5%, ≥5% but <7.5%, and ≥7.5%, respectively. A multivariable analysis revealed age, male sex, waist circumference, diabetes, and low-density lipoprotein cholesterol level as independently associated with annualized CAC progression (p<0.001, p=0.017, p=0.025, p=0.032, and p=0.003, respectively).
CONCLUSIONS
The probability of CAC progression is very low in Korean individuals with a CAC score of zero. However, the risk of CAC progression increases nonlinearly over time, and increases as the 10-year ASCVD risk increases.

Keyword

Coronary arteries; Calcium; Risk assessment

MeSH Terms

Calcium*
Cardiovascular Diseases
Cholesterol
Coronary Vessels*
Follow-Up Studies
Humans
Korea
Lipoproteins
Male
Retrospective Studies
Risk Assessment
Risk Factors
Waist Circumference
Calcium
Cholesterol
Lipoproteins

Figure

• 

  Figure 1 Patient selection flowchart. CAC = coronary artery calcium.

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  Figure 2 CAC progression in individuals with a baseline CAC score of zero according to the 10-year ASCVD risk score. (A) Absolute changes in CAC score between the first and last scan are shown. (B) Annualized CAC progression rate is presented. ASCVD = atherosclerotic cardiovascular disease; CAC = coronary artery calcium.

• 

  Figure 3 The cumulative proportion of CAC progression. (A) The Kaplan-Meier curve for the total study population is depicted. (B) CAC progression is stratified by the 10-year ASCVD risk. ASCVD = atherosclerotic cardiovascular disease; CAC = coronary artery calcium.

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