Evolving Role of Calcium Density in Coronary Artery Calcium Scoring and Atherosclerotic Cardiovascular Disease Risk.

Journal Article (Journal Article;Review)

Coronary artery calcium (CAC) is a specific marker of coronary atherosclerosis that can be used to measure calcified subclinical atherosclerotic burden. The Agatston method is the most widely used scoring algorithm for quantifying CAC and is expressed as the product of total calcium area and a quantized peak calcium density weighting factor defined by the calcification attenuation in HU on noncontrast computed tomography. Calcium density has emerged as an important area of inquiry because the Agatston score is upweighted based on the assumption that peak calcium density and atherosclerotic cardiovascular disease (ASCVD) risk are positively correlated. However, recent evidence demonstrates that calcium density is inversely associated with lesion vulnerability and ASCVD risk in population-based cohorts when accounting for age and plaque area. Here, we review calcium density by focusing on 3 main areas: 1) CAC scan acquisition parameters; 2) pathophysiology of calcified plaques; and 3) epidemiologic evidence relating calcium density to ASCVD outcomes. Through this process, we hope to provide further insight into the evolution of CAC scoring on noncontrast computed tomography.

Full Text

Duke Authors

Cited Authors

  • Razavi, AC; Agatston, AS; Shaw, LJ; De Cecco, CN; van Assen, M; Sperling, LS; Bittencourt, MS; Daubert, MA; Nasir, K; Blumenthal, RS; Mortensen, MB; Whelton, SP; Blaha, MJ; Dzaye, O

Published Date

  • September 2022

Published In

Volume / Issue

  • 15 / 9

Start / End Page

  • 1648 - 1662

PubMed ID

  • 35861969

Electronic International Standard Serial Number (EISSN)

  • 1876-7591

Digital Object Identifier (DOI)

  • 10.1016/j.jcmg.2022.02.026


  • eng

Conference Location

  • United States