Coronary Artery Calcium and Carotid Artery Intima Media Thickness and Plaque: Clinical Use in Need of Clarification
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- Zaid Maryam
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science
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- Fujiyoshi Akira
- Department of Public Health, Shiga University of Medical Science
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- Kadota Aya
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science Department of Public Health, Shiga University of Medical Science
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- Abbott Robert D.
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science
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- Miura Katsuyuki
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science Department of Public Health, Shiga University of Medical Science
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Description
<p>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.</p>
Journal
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- Journal of Atherosclerosis and Thrombosis
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Journal of Atherosclerosis and Thrombosis 24 (3), 227-239, 2017
Japan Atherosclerosis Society