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Review
. 2017 Jun 1;1(6):588-599.
doi: 10.1210/js.2016-1080.

Management of Asymptomatic Patients With Positive Coronary Artery Calcium Scans

Mark R Burge  1 , R Philip Eaton  1 , George Comerci  2 , Brendan Cavanaugh  3 , Barry Ramo  3 , David S Schade  1
Affiliations
Review

Management of Asymptomatic Patients With Positive Coronary Artery Calcium Scans

Mark R Burge et al. J Endocr Soc. .

Abstract

Background: The widespread availability of the coronary artery calcium scan to diagnose coronary artery atheroma semiquantitatively and its prognostic significance has frequently resulted in a difficult therapeutic decision for physicians caring for asymptomatic patients.

Patients and risk factors: Of particular concern are patients over 40 years of age and young adults characterized by multiple cardiovascular risk factors. The correct prognostic interpretation of coronary artery calcium scores and the potential benefits and risks of various therapeutic modalities need to be understood.

Conclusion: This review describes the therapeutic choices available to endocrinologists and provides recommendations for various treatment options.

Keywords: LDL cholesterol; calcium scan; coronary angiography; heart disease; statins; stress testing.

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Figures

Figure 1.
Figure 1.
Cumulative incidence of any coronary event over 4 to 5 years of follow-up after receiving a CAC score evaluation among 6722 multiethnic men and women without preexisting cardiovascular disease in the MESA study. Adapted from Detrano et al. [23].
Figure 2.
Figure 2.
The importance of both the calcium score and the number of risk factors in determining the prognosis of individuals. The composite scores may be easily obtained by using the MESA risk calculator as described in the text. Adapted from Silverman et al. [25]. The risk factors considered to construct the bar graphs were: current smoking, hypertension, diabetes, and a family history of coronary heart disease. Definitions of these risk factors are provided in Silverman et al. [25].
Figure 3.
Figure 3.
Treatment recommendations for an asymptomatic patient presenting with a positive calcium scan. The algorithm is based on aggressively addressing the four main cardiovascular risk factors, including abnormal lipids, hypertension, diabetes, and smoking through lifestyle improvement and medication prescription and adherence. EKG, electrocardiogram; hsCRP, high-sensitivity C-reactive protein.
See this image and copyright information in PMC

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