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Coronary calcium scores: From histology to preventive cardiology
International Journal of Cardiology 229 (2017) 34
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Correspondence
Coronary calcium scores: From histology to preventive cardiology Daniel Bos a,b,c,⁎, Maarten J.G. Leening b,c,d a
Department of Radiology and Nuclear Medicine, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands Department of Epidemiology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands c Department of Epidemiology, Harvard School of Public Health, Boston, MA, United States d Department of Cardiology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands b
a r t i c l e
i n f o
Article history: Received 4 November 2016 Accepted 21 November 2016 Available online 6 December 2016 Keywords: Coronary calcium Atherosclerosis Prevention
With great interest we read the article by Dr. Meershoek and colleagues who concluded that “histological evaluation disqualifies intima-media thickness and coronary calcium scores as surrogates for grading coronary and aortic atherosclerosis” [1]. We find this assertion firmly overstated for coronary artery calcium (CAC) scores, since it disregards the paramount contributions of CAC to our current understanding of atherosclerosis and risk prediction of coronary heart disease. The current study confirms the well-established knowledge that the absence of CAC does not eliminate the possibility of the presence of noncalcified atherosclerosis. Yet, from the preventive cardiology perspective we disagree with the authors to disqualify CAC as surrogate for coronary atherosclerosis. It has been repeatedly shown that the absence of CAC (i.e. advanced atherosclerosis) is accompanied by a mid-to-longterm risk of coronary events and heart failure that is close to zero [2,3]. Additionally, robust population-based evidence has demonstrated that increasing CAC scores reflect a markedly increased risk of future coronary events, without evidence for a specific CAC threshold beyond
DOI of original article: http://dx.doi.org/10.1016/j.ijcard.2016.09.043. ⁎ Corresponding author at: Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands. E-mail address: [email protected] (D. Bos).
http://dx.doi.org/10.1016/j.ijcard.2016.11.299 0167-5273/© 2016 Elsevier Ireland Ltd. All rights reserved.
which plateauing of risk occurs as suggested by Dr. Meershoek and colleagues [4,5]. From a histology perspective an apparent disconnect may arise between CAC and coronary atherosclerosis in small samples of young organ donors, of whom a considerable portion died from cardiovascular events [1]. Yet, from a preventive cardiology perspective at population level, CAC is currently the strongest and most robust risk marker to identify asymptomatic individuals at increased coronary risk [4]. Clearly, appreciation of the value of CAC depends on the scope of the lens through which it is evaluated. Conflict of interest The authors report no relationships that could be construed as a conflict of interest. References [1] A. Meershoek, R.A. van Dijk, S. Verhage, J.F. Hamming, A.J. van den Bogaerdt, A.J. Bogers, et al., Histological evaluation disqualifies IMT and calcification scores as surrogates for grading coronary and aortic atherosclerosis, Int. J. Cardiol. 224 (2016) 328–334. [2] H.S. Hecht, A zero coronary artery calcium score: priceless, J. Am. Coll. Cardiol. 55 (2010) 1118–1120. [3] M.J. Leening, S.E. Elias-Smale, M. Kavousi, J.F. Felix, J.W. Deckers, R. Vliegenthart, et al., Coronary calcification and the risk of heart failure in the elderly: the Rotterdam study, JACC Cardiovasc. Imag. 5 (2012) 874–880. [4] M. Kavousi, S. Elias-Smale, J.H. Rutten, M.J. Leening, R. Vliegenthart, G.C. Verwoert, et al., Evaluation of newer risk markers for coronary heart disease risk classification: a cohort study, Ann. Intern. Med. 156 (2012) 438–444. [5] T.S. Polonsky, R.L. McClelland, N.W. Jorgensen, D.E. Bild, G.L. Burke, A.D. Guerci, et al., Coronary artery calcium score and risk classification for coronary heart disease prediction, JAMA 303 (2010) 1610–1616.
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Correspondence
Coronary calcium scores: From histology to preventive cardiology Daniel Bos a,b,c,⁎, Maarten J.G. Leening b,c,d a
Department of Radiology and Nuclear Medicine, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands Department of Epidemiology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands c Department of Epidemiology, Harvard School of Public Health, Boston, MA, United States d Department of Cardiology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands b
a r t i c l e
i n f o
Article history: Received 4 November 2016 Accepted 21 November 2016 Available online 6 December 2016 Keywords: Coronary calcium Atherosclerosis Prevention
With great interest we read the article by Dr. Meershoek and colleagues who concluded that “histological evaluation disqualifies intima-media thickness and coronary calcium scores as surrogates for grading coronary and aortic atherosclerosis” [1]. We find this assertion firmly overstated for coronary artery calcium (CAC) scores, since it disregards the paramount contributions of CAC to our current understanding of atherosclerosis and risk prediction of coronary heart disease. The current study confirms the well-established knowledge that the absence of CAC does not eliminate the possibility of the presence of noncalcified atherosclerosis. Yet, from the preventive cardiology perspective we disagree with the authors to disqualify CAC as surrogate for coronary atherosclerosis. It has been repeatedly shown that the absence of CAC (i.e. advanced atherosclerosis) is accompanied by a mid-to-longterm risk of coronary events and heart failure that is close to zero [2,3]. Additionally, robust population-based evidence has demonstrated that increasing CAC scores reflect a markedly increased risk of future coronary events, without evidence for a specific CAC threshold beyond
DOI of original article: http://dx.doi.org/10.1016/j.ijcard.2016.09.043. ⁎ Corresponding author at: Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands. E-mail address: [email protected] (D. Bos).
http://dx.doi.org/10.1016/j.ijcard.2016.11.299 0167-5273/© 2016 Elsevier Ireland Ltd. All rights reserved.
which plateauing of risk occurs as suggested by Dr. Meershoek and colleagues [4,5]. From a histology perspective an apparent disconnect may arise between CAC and coronary atherosclerosis in small samples of young organ donors, of whom a considerable portion died from cardiovascular events [1]. Yet, from a preventive cardiology perspective at population level, CAC is currently the strongest and most robust risk marker to identify asymptomatic individuals at increased coronary risk [4]. Clearly, appreciation of the value of CAC depends on the scope of the lens through which it is evaluated. Conflict of interest The authors report no relationships that could be construed as a conflict of interest. References [1] A. Meershoek, R.A. van Dijk, S. Verhage, J.F. Hamming, A.J. van den Bogaerdt, A.J. Bogers, et al., Histological evaluation disqualifies IMT and calcification scores as surrogates for grading coronary and aortic atherosclerosis, Int. J. Cardiol. 224 (2016) 328–334. [2] H.S. Hecht, A zero coronary artery calcium score: priceless, J. Am. Coll. Cardiol. 55 (2010) 1118–1120. [3] M.J. Leening, S.E. Elias-Smale, M. Kavousi, J.F. Felix, J.W. Deckers, R. Vliegenthart, et al., Coronary calcification and the risk of heart failure in the elderly: the Rotterdam study, JACC Cardiovasc. Imag. 5 (2012) 874–880. [4] M. Kavousi, S. Elias-Smale, J.H. Rutten, M.J. Leening, R. Vliegenthart, G.C. Verwoert, et al., Evaluation of newer risk markers for coronary heart disease risk classification: a cohort study, Ann. Intern. Med. 156 (2012) 438–444. [5] T.S. Polonsky, R.L. McClelland, N.W. Jorgensen, D.E. Bild, G.L. Burke, A.D. Guerci, et al., Coronary artery calcium score and risk classification for coronary heart disease prediction, JAMA 303 (2010) 1610–1616.