Coronary artery calcium in the general population, patients with chronic kidney disease and diabetes mellitus

Abstract

Abstract Coronary artery calcium (CAC) is closely associated with the burden of atherosclerotic plaque, and it represents approximately 15–20% of the total plaque volume. As atherosclerosis is a universal disease of human kind, CAC distribution in subjects of different age, sex, and race provides an image of the epidemiology of this coronary artery disease. The impact of specific disease states, such as diabetes mellitus and chronic kidney disease, on the development of coronary atherosclerosis can also be traced with CAC imaging. Of interest, the prognostic significance of CAC is not the same for all carriers of this marker, although it is established that its mere presence increases the probability of cardiovascular events and death. CAC detected by cardiac computed tomography is quantified with three different scores. The most frequently used is the Agatston score that is calculated by multiplying the area of a calcified lesion by a coefficient, from 1 to 4, based on the peak radiodensity detected within the calcified area. The volume score is more reproducible than the Agatston score, and it is calculated as the sum of all voxels within a calcified plaque with an attenuation greater than 130 Hounsfield units. The third score is the mass score that gives a more precise estimate of calcium content in the plaque. In this chapter, we discuss the current knowledge on the distribution and impact of CAC in patients of different races, sex, and age as well as in special disease states.