Key result
High ASCVD risk linked to ~28% CAC progression over five years despite zero baseline calcium.
Why the study?
Coronary artery calcium scoring in asymptomatic individuals with an initial score of zero and its progression over time with risk factors was not well characterized in a Korean population.
Observational (n=6,268)
Yes
Absolute Event Rate: 27.9% vs 13.1%
p-value: p=<0.001
In asymptomatic Korean individuals with a baseline CAC score of zero, the probability of CAC progression is very low initially but increases nonlinearly over time and with higher 10-year ASCVD risk.
May guide risk-stratified CAC rescreening intervals in zero-score patients; leaves open impact on outcomes.
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.
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Lee et al. (2019) conducted an observational in Asymptomatic with baseline coronary artery calcium score of zero (n=6,268). High 10-year ASCVD risk (≥7.5%) vs. Low 10-year ASCVD risk (<5%) was evaluated on Coronary artery calcium (CAC) progression at 5 years (p=<0.001). In asymptomatic individuals with a baseline coronary artery calcium score of zero, the 5-year probability of CAC progression increased significantly from 13.1% in those with low ASCVD risk to 27.9% in those with high ASCVD risk.
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