Population-based assessment of subclinical coronary atherosclerosis using electron-beam computed tomography

Aims Coronary artery calcification (CAC) is determined as a measure of the extent of coronary atherosclerosis and can be used for expanded cardiovascular risk stratification. It was our aim to establish reference CAC scores in a population-based unselected European cohort. Methods and results The Heinz Nixdorf Recall study (HNR) recruited a total of 4814 participants aged 45–74 years. Cardiovascular risk factors and medications were recorded, and CAC was measured using electron-beam CT (EBCT). CAC score distribution was compared with previous studies in subjects who were self-referred, volunteered, or were physician-referred. Of the 4472 (92.9%) subjects free of clinical coronary artery disease, the CAC score was available in 4275 (95.3%) (2027 men, 2248 women). CAC scores were lower in particular in the higher age groups (≥60 years) in men than in the previous studies. Also, in most age groups (except the highest, 70–74 years), subjects with no cardiovascular medications had significantly lower CAC scores than subjects using cardiovascular medications. Conclusions The current report characterises the distribution of EBCT-derived CAC scores in a European unselected population. Compared with previous reports, CAC scores were lower in our cohort, in particular in subjects not receiving cardiovascular medications. Classification of the CAC score may underestimate true risk if previously published referral cohorts are used as the reference.