Understanding the Low-Risk Population with Coronary Artery Calcifications

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  • January 29, 2020
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  • Tannu, Manasi
    • Affiliation: Gillings School of Global Public Health, Public Health Leadership Program
Abstract
  • Abstract: Background: Coronary artery calcium (CAC) assessment has been proposed as a possible method for improving identification of persons at risk for cardiovascular disease (CVD). Current cardiovascular risk prediction algorithms identify high risk people because they have the greatest potential benefit from prevention interventions. However, since high risk people comprise a small percentage of the population, the greatest absolute number of CVD occurrences happens among people at low or intermediate risk.1 The objective of this study was to assess the prevalence of CAC and advanced CAC in low-risk populations and determine the demographics and non-invasive lab characteristics of low risk adults with CAC. Methods: In a cross-sectional analysis, we studied 420 non-diabetic participants who were not on lipid lowering therapy or anti-hypertensive medications. Bivariate analyses were used to assess the presence of CAC and advanced CAC (defined as Agatston Score >= 400) in the subset of the population deemed “low risk” by the Framingham Risk Score (FRS <7.5%) for whom statin therapy would not generally be recommended. Further bivariate analysis was performed to assess the cardiac risk factors (age, sex, cholesterol level, systolic blood pressure (BP), 24 hour ambulatory BP and smoking status) of low-risk persons who had CAC and advanced CAC. Results: Of the 420 people in this study, we identified 250 low-risk participants (FRS<7.5%), 34% of whom had CAC and 22% with advanced CAC. Among the subset of low-risk patients who had CAC, 33% were male, 7% were smokers, the mean age was 45 years, mean total cholesterol was 196 mg/dl, HDL 59 mg/dl, systolic blood pressure 119 mmHg, 24 hour ambulatory BP 139, and mean BMI was 29. Among this low-risk cohort, no traditional cardiac risk factors (age, total cholesterol, HDL cholesterol, systolic BP, 24 hour ambulatory BP, race, gender, smoking status) were associated with presence of CAC. The low-risk people with advanced CAC (Agatston Score >= 400) were 24% male with a mean age of 43 years, total cholesterol 194 mg/dl, HDL 61 mg/dl, systolic BP 120 mmHg, 24hr ambulatory BP of 139, mean BMI of 27 and 9% smokers. Among these low risk patients, female sex was the only factor significantly associated with the presence of advanced CAC. Conclusions: Among a low-risk sample of patients (FRS<7.5%), traditional risk factors (age, total cholesterol, HDL cholesterol, BP, race) were not associated with presence of CAC or presence of advanced CAC. Female sex was the only demographic associated with presence of advanced CAC in low-risk persons.
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  • In Copyright
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  • Paper type: Research or research design
  • Track: HC&P
Advisor
  • Viera, Anthony
Reviewer
  • Hinderliter, Alan
Degree
  • Master of Public Health
Degree granting institution
  • University of North Carolina at Chapel Hill
Graduation year
  • 2016
Language
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  • 7f08b3ce-95e1-4548-b091-47d49461c4ae

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