Coronary Artery Calcium Found in 1/3 Women Designated “Low-Risk’ Interview with:


Dr. Maryam Kavousi

Maryam Kavousi MD, PhD, FESC
Assistant Professor
Department of Epidemiology
Erasmus University Medical Center
Rotterdam The Netherlands What is the background for this study? What are the main findings?

Response: The most recent American College of Cardiology/American Heart Association (ACC/AHA) cardiovascular disease (CVD) prevention guidelines recommend statins for a larger proportion of populations.

Notably, a large group of women are categorized as low CVD risk by the guidelines and would therefore not typically qualify for intensive management of their standard risk factors. Coronary artery calcium (CAC) scanning allows for the detection of subclinical coronary atherosclerosis and is viewed as the vessel’s memory of lifetime exposure to risk factors. We therefore aimed to address the utility of CAC as a potential tool for refining CVD risk assessment in asymptomatic women at low CVD risk based on the new guidelines.

This study involved data on 6,739 low-risk women from 5 population-based cohort studies across the United States and Europe. We found that CAC was present in 36% of low-risk women and was associated with increased risk of CVD. What should readers take away from your report?

Response: Among women who were categorized as being at low risk for CVD based on the most recent ACC/AHA guidelines, evidence for atherosclerosis of coronary arteries was present in one-third and was associated with increased risk for cardiovascular disease. Coronary artery calcium testing might have the potential to improve CVD risk predictions and to further risk stratify asymptomatic women categorized as low risk by the recent guidelines. What recommendations do you have for future research as a result of this study?

Response: Findings from the current study support the need for further studies to better define which group of low-risk women have the highest yield from coronary artery calcium testing. Besides considering the cost-effectiveness, the ultimate decision regarding application of CAC testing among women at low cardiovascular risk remains to be verified in randomized controlled trials testing the value of CAC in improving the outcomes. Is there anything else you would like to add?

Response: Considering that the importance of timely prevention and proper management of CVD as one of the major health issues among women is sometimes ignored, coronary artery calcium testing might improve therapeutic compliance not only in terms of adherence to medication but also with life style changes including diet and exercise. However, although the amount of radiation for CAC scanning is small, the balance of risks and benefits of this additional diagnostic testing needs to be considered. Thank you for your contribution to the community.


Kavousi M, Desai CS, Ayers C, Blumenthal RS, Budoff MJ, Mahabadi A, Ikram MA, van der Lugt A, Hofman A, Erbel R, Khera A, Geisel MH, Jöckel K, Lehmann N, Hoffmann U, O’Donnell CJ, Massaro JM, Liu K, Möhlenkamp S, Ning H, Franco OH, Greenland P. Prevalence and Prognostic Implications of Coronary Artery Calcification in Low-Risk WomenA Meta-analysis. JAMA. Published online November 15, 2016. doi:10.1001/jama.2016.17020

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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