Coronary Artery Calcification by Computed Tomography in Epidemiologic Research and Cardiovascular Disease Prevention

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  • Sekikawa Akira
    Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh
  • Curb J. David
    Department of Geriatric Medicine, the John A. Burns School of Medicine, University of Hawaii
  • Edmundowicz Daniel
    UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center
  • Okamura Tomonori
    Department of Preventive Medicine and Public Health, School of Medicine, Keio University
  • Choo Jina
    Department of Community Health Nursing, College of Nursing, Korea University
  • Fujiyoshi Akira
    Department of Health Science, Shiga University of Medical Science
  • Masaki Kamal
    Department of Geriatric Medicine, the John A. Burns School of Medicine, University of Hawaii
  • Miura Katsuyuki
    Department of Health Science, Shiga University of Medical Science
  • Kuller Lewis H.
    Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh
  • Shin Chol
    Department of Internal Medicine, Korea University
  • Ueshima Hirotsugu
    Department of Health Science, Shiga University of Medical Science

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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.

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