Arterial Calcification in Cardiovascular Risk Prediction

There is considerable controversy regarding the most effective means to reduce the global burden of cardiovascular disease (CVD). Although traditional metrics, such as the Pooled Cohort atherosclerotic cardiovascular disease (ASCVD) risk equation, remains essential in providing a comprehensive assessment of CVD risk,1 there is also a well-established body of evidence on the utility of noninvasive imaging. Accordingly, imaging has been frequently applied to detect subclinical atherosclerosis and differentiate among at-risk individuals those who would benefit from more intensive therapies in the primary prevention of CVD.2 Specifically, advanced imaging modalities have been used to target well-defined subcomponents of atheromatous disease, such as coronary artery calcification (CAC), as a means to further improve detection of high risk individuals.See Article by Bos et al scoring, in particular, has been shown to provide significant value in estimating CVD events with higher strata of Agatston scores corresponding with increasing elevations of risk.3 Importantly, the development of atherosclerotic disease is not exclusive to the coronary arteries but rather is a systemic process that develops in heart valves, throughout the aorta, and peripheral arteries. Differential rates and patterns of plaque development exist within each vascular bed mediated by clinical, genetic, and comorbid factors associated with atherosclerosis.4 Thus, given the heterogeneous distribution and variable degrees of atherosclerotic progression, the utility of imaging the coronaries alone is expectedly suboptimal for estimating the total burden of CVD risk.Current evidence for the prognostic significance of extracoronary calcification, in particular as it relates to added prognostic value above CAC …