Coronary artery calcium (CAC) may improve risk stratification for patients with coronary
heart disease (CHD) beyond traditional risk factors. Subjects from the Framingham
Heart Study Offspring and Third Generation cohorts (48% women; mean age 53 years)
underwent noncontrast electrocardiographically triggered cardiac multidetector computed
tomography. The prevalence of absolute CAC (Agatston score [AS] >0, >100, and >400)
and relative age- and gender-specific strata (25th, 50th, 75th, 90th, and 95th percentiles)
were determined in a healthy subset free of clinically apparent cardiovascular disease
or CHD risk factors (n = 1,586), the overall sample at risk (n = 3,238), and subjects
at intermediate Framingham risk score (FRS; 6% to 20% 10-year CHD event risk; n =
1,177). Absolute AS and relative cutoffs for CAC increased with age and FRS, were
higher in men compared with women in each of the 3 cohorts, and increased from the
healthy subset to the overall cohort to subjects at intermediate risk. However, in
subjects with CAC, there was substantial disagreement between absolute and relative
cut-off values for labeling subjects as having increased CAC. In general, more subjects
were considered to have increased CAC using relative cut-off values, especially in
women and younger subjects. Fewer subjects at intermediate FRS had increased CAC using
comparable absolute versus relative cutoffs (men 32% at AS >100 vs 36% at >75th percentile;
women 24% at AS >100 vs 34% at >75th percentile). In conclusion, we provided distributions
of CAC in a healthy subset, the overall cohort, and subjects at intermediate risk
from the Framingham Heart Study for both absolute and relative cut-off values for
CAC. Absolute cutoffs underestimated the proportion of subjects with increased CAC,
specifically in women, younger persons, and persons at intermediate CHD risk.
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Article info
Publication history
Published online: August 26, 2008
Accepted:
June 30,
2008
Received in revised form:
June 30,
2008
Received:
March 12,
2008
Footnotes
This work was supported by the National Heart, Lung, and Blood Institute (NHLBI) Framingham Heart Study (National Institutes of Health/NHLBI Contract N01-HC-25195, Bethesda, maryland), Framingham, Massachusetts.
Identification
Copyright
© 2008 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
