title: Coronary artery calcification by computed tomography in epidemiologic research and cardiovascular disease prevention.
abstract: Both American and European guidelines recommend coronary artery calcification (CAC) as a tool for screening asymptomatic individuals at intermediate risk for coronary heart disease (CHD). These recommendations are based on epidemiologic studies mostly in the United States. We review (1) the use of CAC in primary prevention of CHD in the United States, (2) epidemiologic studies of CAC in asymptomatic adults outside of the United States, and (3) international epidemiologic studies of CAC. This review will not consider clinical studies of CAC among patients or symptomatic individuals. US studies have shown that CAC is a strong independent predictor of CHD in both sexes among middle-aged and old age groups, various ethnic groups, and individuals with and without diabetes and that CAC plays an important role in reclassifying individuals from intermediate to high risk. Studies in Europe support these conclusions. The Electron-Beam Tomography, Risk Factor Assessment Among Japanese and US Men in the Post-World-War-II birth cohort (ERA JUMP) Study is the first international study to compare subclinical atherosclerosis, including CAC among Japanese, Japanese Americans, Koreans, and whites. It showed that as compared with whites, Japanese had lower levels of atherosclerosis, whereas Japanese Americans had similar or higher levels. CAC is being increasingly used as a screening tool for asymptomatic individuals in Europe and the United States. CAC is a powerful research tool, because it enables us to describe differences in atherosclerotic burden across populations. Such research could identify factors responsible for differences among populations, which may improve CHD prevention.
authors.affiliation: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA 15213, USA. akira@pitt.edu
authors.forename: Akira
authors.initials: A
authors.lastname: Sekikawa
authors.forename: J David
authors.initials: JD
authors.lastname: Curb
authors.forename: Daniel
authors.initials: D
authors.lastname: Edmundowicz
authors.forename: Tomonori
authors.initials: T
authors.lastname: Okamura
authors.forename: Jina
authors.initials: J
authors.lastname: Choo
authors.forename: Akira
authors.initials: A
authors.lastname: Fujiyoshi
authors.forename: Kamal
authors.initials: K
authors.lastname: Masaki
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Miura
authors.forename: Lewis H
authors.initials: LH
authors.lastname: Kuller
authors.forename: Chol
authors.initials: C
authors.lastname: Shin
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Ueshima
mesh_terms: D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000208:ethnology; D003327:Coronary Disease / Q000175:diagnosis / Q000453:epidemiology / Q000208:ethnology / Q000517:prevention & control*; D016021:Epidemiologic Studies; D006801:Humans; D011322:Primary Prevention; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed; D014481:United States; D061205:Vascular Calcification / Q000000981:diagnostic imaging* / Q000208:ethnology