title: Discordance between Risk Factors and Coronary Artery Calcium: Implications for Guiding Treatment Strategies in Primary Prevention Settings.
abstract: Preventive efforts including smoking cessation campaigns, increased awareness of healthy lifestyle habits, risk factor modification, and the appropriate use of statins have been successful in reducing cardiovascular mortality over the last decade. The coronary artery calcium (CAC) scan has reliably been an additive predictor to traditional risk estimation methods, partly because of the heterogeneity between risk factor burden and atherosclerotic burden. The focus of this review is to highlight this heterogeneity by focusing on groups in which risk factor burden and subclinical atherosclerosis burden, as measured by CAC, are discordant. In high-risk groups with 0 CAC, the event rates are consistently low; in low-risk groups with elevated CAC (CAC>100), the event rates are consistently high. We conclude with our clinical perspective of the considerable heterogeneity between risk factors and atherosclerotic burden in the context of the 2013 ACC/AHA cholesterol treatment and risk assessment guidelines.
authors.affiliation: Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Parag H
authors.initials: PH
authors.lastname: Joshi
authors.affiliation: Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA; Center for Healthcare Advancement & Outcomes, Baptist Health South Florida, Miami, FL, USA; Miami Cardiac & Vascular Institute, Baptist Health South Florida, Miami, FL, USA; Department of Medicine, Herbert Wertheim College of Medicine; Florida International University, Miami, FL, USA; Department of Epidemiology, Robert Stempel College of Public Health; Florida International University, Miami, FL, USA. Electronic address: khurramn@baptisthealth.net.
authors.forename: Khurram
authors.initials: K
authors.lastname: Nasir
mesh_terms: D000367:Age Factors; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D020022:Genetic Predisposition to Disease; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D010375:Pedigree; D017410:Practice Guidelines as Topic / Q000592:standards*; D011237:Predictive Value of Tests; D011322:Primary Prevention / Q000379:methods / Q000592:standards*; D065840:Protective Factors; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012907:Smoking / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D061205:Vascular Calcification / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Cardiovascular disease; Coronary artery calcium; Coronary heart disease; Risk factors