Article Impact Level: HIGH Data Quality: STRONG Summary of JACC: Cardiovascular Imaging, 0(0). https://doi.org/10.1016/j.jcmg.2022.06.018 Dr. Matthew Budoff et al
Points
- This paper aims to summarize the guideline about coronary artery calcium (CAC) used in the risk management of atherosclerotic cardiovascular disease (ASCVD) for use in clinical and preventive therapeutic settings.
- Different cardiovascular societies across the world presented recommendations about using CAC, and this review presented the most prominent common features after comparing similarities and differences between those recommendations.
- However, some differences do exist, but the guidelines specifically focused on similarities related to clinical and functional points of view.
- Understanding these guidelines is necessary for practitioners to appropriately administer aspirin, statin therapy, and other medical management.
Summary
This article summarizes the guidelines regarding the use of the global coronary artery calcium (CAC) score. The following are the main key points:
- Guidelines used for treating coronary heart disease (CHD) have a set of instructions that helps clinicians and patients in decision-making. This review provides guidelines for using CAC scores in the risk assessment of ASCVD.
- The use of CAC varies in different clinical settings. This review presented the most common characteristics of CAC after comparing recommendations from different clinical societies.
- Risk assessment tools that can help reduce the rate of CHD morbidity and mortality are needed, and an understanding of CAC guidelines will help the practitioners appropriately use aspirin, statin, antihypertensive therapy, and CAC rescanning.
- Regardless of similarities, these global guidelines vary, especially concerning CAC scoring regarding risk stratifications.
- The American Heart Association/ American College of Cardiology focuses on risk factors and factors that can enhance the risk of ASCVD and provide guidelines for adults at intermediate risk or at borderline. They proposed that if risk-based choices for preventive interventions remain ambiguous, consider CAC; otherwise, statin therapy is the best choice at any age.
- The guidelines of the Canadian Cardiovascular Society are lenient regarding the use of CAC and statin infrequently. And if the patient is at high risk, add ezetimibe with a statin.
- The criteria for statin use are very tight according to the guidelines of Australia and New Zealand. They suggest using statin when the CAC score is above the 75th percentile and above 400.
- The agreed high-risk score of CAC at which statin should be initiated is between 101-400.
- Low-risk unit is defined as less than 5% or less CAC, but CAC greater than 100 should be considered for statin use.
- Although there are variations between country guidelines, there are also differences between and within specialty guidelines related to using the CAC score as an indicator.
- Not a single simple protocol is provided by any country. Some favor a greater CAC score for the use of statin, and some favor a 1-99 score of CAC and recommend statin therapy for all ages and sex.
- The most logical use of CAC is that it qualifies the patients for the use of statin, which is an inexpensive treatment for ASCVD.
Link to the article: https://www.jacc.org/doi/10.1016/j.jcmg.2022.06.018
References Golub, I. S., Termeie, O. G., Kristo, S., Schroeder, L. P., Lakshmanan, S., Shafter, A. M., Hussein, L., Verghese, D., Aldana, -Bitar Jairo, Manubolu, V. S., & Budoff, M. J. (n.d.). Major global coronary artery calcium guidelines. JACC: Cardiovascular Imaging, 0(0). https://doi.org/10.1016/j.jcmg.2022.06.018
