Absolute coronary artery calcium (CAC) scores and CAC percentiles can identify different
patient groups, which could be confusing in clinical practice. We aimed to create
a simple “rule of thumb” for identifying the American College of Cardiology/American
Heart Association endorsed 75th CAC percentile based on age, gender, and the absolute
CAC score. Using the Multi-Ethnic Study of Atherosclerosis, we calculated the age
and gender-specific percent likelihood that a guideline-based absolute CAC score group
(1 to 100, 100 to 300, >300) will place a patient above the 75th percentile. Also,
we derived gender-specific age cutoffs by which 95% of participants with any (>0),
moderate (≥100), or severe (≥300) CAC score would be over the 75th percentile. We
repeated the analysis using the 90th percentile threshold and also conducted sensitivity
analyses stratified by race. Any CAC >0 places 95% of women younger than 60 years
and over 90% of men younger than 50 years over the 75th percentile. Moderate absolute
CAC scores (>100) place nearly all men <60 years and all women <70 years over the
75th percentile. Confirmatory analysis for age cutoffs was consistent with primary
analysis, with cutoffs of 48 years for men and 59 years for women indicating a 95%
likelihood that any CAC would place patients over the 75th percentile. In conclusion,
our study provides a simple rule of thumb (men <50 years and women <60 years with
any CAC, men <60 years and women <70 years with CAC >100) for identifying CAC >75th
percentile that might be readily adopted in clinical practice.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines.Circulation. 2019; 140: e596-e646
- 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: executive summary: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines.J Am Coll Cardiol. 2019; 73: 3168-3209
- Clinical indications for coronary artery calcium scoring in asymptomatic patients: expert consensus statement from the Society of Cardiovascular Computed Tomography.J Cardiovasc Comput Tomogr. 2017; 11: 157-168
- Coronary artery calcium: need for more clarity in guidelines.JACC Cardiovasc Imaging. 2017; 10: 154-156
- Multi-Ethnic Study of Atherosclerosis: objectives and design.Am J Epidemiol. 2002; 156: 871-881
- Distribution of coronary artery calcium by race, gender, and age: results from the Multi-Ethnic Study of Atherosclerosis (MESA).Circulation. 2006; 113: 30-37
- Distribution of coronary artery calcium by age, sex, and race among patients 30–45 years old.J Am Coll Cardiol. 2022; 79: 1873-1886
Article Info
Publication History
Published online: July 25, 2022
Received in revised form:
May 16,
2022
Received:
January 31,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Authors Albert D. Osei and Mohammadhassan Mirbolouk contributed equally to this manuscript.
This research was supported by contracts HHSN268201500003I, N01-HC-95159 through N01-HC-95169 from the National Heart, Lung, and Blood Institute, United States and by grants UL1-TR-000040, UL1-TR-001079, UL1-TR-001420 and UL1-TR-001881 from the National Center for Advancing Translational Sciences, United States.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
