Assessment of cardiovascular calcium: Interpretation, prognostic value, and relationship to lipids and other cardiovascular risk factors

Cardiac risk assessment has traditionally been based on conventional risk factors; the shortcomings of this approach are all too often highlighted by major cardiac events occurring in presumably low-risk people. The annual presentation of 650,000 previously asymptomatic patients with an acute coronary event as the initial manifestation of coronary artery disease (CAD) [1] is a testimony to the failure of our current risk assessment model. Consequently, there has been a focus on markers of subclinical atherosclerosis that may be utilized for risk assessment of individuals, rather than extrapolating from risk factors that reflect trends in large groups of patients in epidemiologic studies. The most powerful of these subclinical markers is coronary artery calcium (CAC).