The absence of coronary calcium: clinical and therapeutic implications for the clinical lipidologist.
BACKGROUND
Cardiac computed tomography for coronary artery calcium scoring, a diagnostic test associated with relatively low radiation exposure, provides incremental coronary risk stratification above that provided by Framingham risk scoring in asymptomatic, intermediate-risk patients. Knowledge of the appropriate use of coronary calcium scoring enables the clinician to more appropriately match the intensity of preventive cardiovascular care to the individual's absolute risk of coronary heart disease (CHD).


METHODS
A Medline search was used for original articles pertinent to coronary artery calcium scoring from 2000 to 2010.


RESULTS
Despite the presence of coronary risk factors, up to 45% of asymptomatic, presumed intermediate-risk patients referred for coronary calcium scoring have no detectable coronary calcium, a finding associated with a 1 to 2% 10-year risk of CHD death or nonfatal myocardial infarction. Such patients could logically be given a more prolonged opportunity to respond to therapeutic lifestyle change and, if necessary, generic lipid-altering medication before more expensive treatment strategies are implemented.


CONCLUSIONS
Because coronary calcium scoring is usually a self-pay test, the test should be ordered only in those circumstances in which knowledge of the results will change coronary risk management. This review addresses these issues and attempts to place the clinical utility of this important diagnostic test in perspective for the clinician.
Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA. carl.orringer@uhhospitals.org
Carl E
CE
Orringer
D002118:Calcium / Q000032:analysis*; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
D002118:Calcium