Although coronary artery calcium and carotid intima-media thickness are promising surrogates of ASCVD in research, their use in clinical practice as screening tools for primary prevention is premature.
Does screening with coronary artery calcium (CAC) or carotid artery intima-media thickness (cIMT) and plaque improve clinical outcomes in asymptomatic adults?
While CAC and cIMT/plaque improve ASCVD risk prediction, their routine clinical use for primary prevention screening in asymptomatic adults remains premature pending outcome trials.
Atherosclerosis begins in early life and has a long latent period prior to onset of clinical disease. Measures of subclinical atherosclerosis, therefore, may have important implications for research and clinical practice of atherosclerotic cardiovascular disease (ASCVD). In this review, we focus on coronary artery calcium (CAC) and carotid artery intima-media thickness (cIMT) and plaque as many population-based studies have investigated these measures due to their non-invasive features and ease of administration. To date, a vast majority of studies have been conducted in the US and European countries, in which both CAC and cIMT/plaque have been shown to be associated with future risk of ASCVD, independent of conventional risk factors. Furthermore, these measures improve risk prediction when added to a global risk prediction model, such as the Framingham risk score. However, no clinical trial has assessed whether screening with CAC or cIMT/plaque will lead to improved clinical outcomes and healthcare costs. Interestingly, similar levels of CAC or cIMT/plaque among various regions and ethnic groups may in fact be associated with significantly different levels of absolute risk of ASCVD. Therefore, it remains to be determined whether measures of subclinical atherosclerosis improve risk prediction in non-US/European populations. Although CAC and cIMT/plaque are promising surrogates of ASCVD in research, we conclude that their use in clinical practice, especially as screening tools for primary prevention in asymptomatic adults, is premature due to many vagaries that remain to be clarified.
Zaid et al. (Wed,) conducted a review in Atherosclerotic cardiovascular disease (ASCVD). Coronary artery calcium (CAC) and carotid artery intima-media thickness (cIMT)/plaque screening vs. Standard risk prediction models (e.g., Framingham risk score) was evaluated. Although coronary artery calcium and carotid intima-media thickness are promising surrogates of ASCVD in research, their use in clinical practice as screening tools for primary prevention is premature.