BACKGROUND There is increasing evidence that coronary artery calcium (CAC) density is inversely associated with plaque vulnerability and atherosclerotic cardiovascular disease risk. OBJECTIVES A systematic review and meta-analysis were performed to examine the predictive value of CAC density for future cardiovascular events in asymptomatic individuals undergoing noncontrast CAC scoring computed tomography. METHODS Electronic databases were searched for studies reporting CAC density and subsequent cardiovascular disease (CVD) or coronary heart disease (CHD) events. Two independent reviewers performed data extraction. Random-effects models were used to estimate pooled HRs and 95% CIs. Subgroup analyses were performed with studies stratified by CVD vs CHD events and by statin use. RESULTS Of 5,029 citations, 5 studies with 6 cohorts met inclusion criteria. In total, 1,309 (6.1%) cardiovascular events occurred in 21,346 participants with median follow-up ranging from 5.2 to 16.7 years. Higher CAC density was inversely associated with risk of cardiovascular events following adjustment for clinical risk factors and CAC volume (HR: 0.80 per SD of density [95% CI: 0.72-0.89]; P < 0.01; I2 = 0%). There was no significant difference in the pooled HRs for CVD vs CHD events (HR: 0.80 per SD [95% CI: 0.71-0.90] vs 0.74 per SD [95% CI: 0.59-0.94] respectively; P = 0.59). The protective association between CAC density and event risk persisted among statin-naive patients (HR: 0.79 per SD [95% CI: 0.70-0.89]; P < 0.01) but not statin-treated patients (HR: 0.97 per SD [95% CI: 0.77-1.22]; P = 0.78); the test for interaction indicated no significant between-group differences (P = 0.12). CONCLUSIONS Higher CAC density is associated with a lower risk of cardiovascular events when adjusted for risk factors and CAC volume. Future work may expand the contribution of CAC density in CAC scoring, and enhance its role in CVD risk assessment, treatment, and prevention.

中文翻译：

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冠状动脉钙密度和心血管事件的风险：系统评价和荟萃分析。


背景越来越多的证据表明冠状动脉钙（CAC）密度与斑块易损性和动脉粥样硬化性心血管疾病风险呈负相关。目的 进行系统评价和荟萃分析，以检查 CAC 密度对接受非对比 CAC 评分计算机断层扫描的无症状个体未来心血管事件的预测价值。方法 在电子数据库中搜索报告 CAC 密度和随后的心血管疾病 (CVD) 或冠心病 (CHD) 事件的研究。两名独立评审员进行了数据提取。使用随机效应模型来估计汇总 HR 和 95% CI。通过按 CVD 与 CHD 事件以及他汀类药物使用分层的研究进行亚组分析。结果 在 5,029 次引用中，有 6 个队列的 5 项研究符合纳入标准。 21,346 名参与者总共发生了 1,309 起（6.1%）心血管事件，中位随访时间为 5.2 至 16.7 年。调整临床危险因素和 CAC 体积后，较高的 CAC 密度与心血管事件风险呈负相关（HR：每密度 SD 0.80 [95% CI：0.72-0.89]；P < 0.01；I2 = 0%）。 CVD 与 CHD 事件的汇总 HR 没有显着差异（HR：分别为 0.80/SD [95% CI：0.71-0.90] vs 0.74/SD [95% CI：0.59-0.94]；P = 0.59）。 CAC 密度和事件风险之间的保护性关联在未接受他汀类药物治疗的患者中持续存在（HR：0.79/SD [95% CI：0.70-0.89]；P < 0.01），但在接受他汀类药物治疗的患者中则不然（HR：0.97/SD [95] ％CI：0.77-1.22]；P = 0.78）；交互作用检验表明组间没有显着差异（P = 0.12）。 结论 根据危险因素和 CAC 体积进行调整后，较高的 CAC 密度与较低的心血管事件风险相关。未来的工作可能会扩大 CAC 密度在 CAC 评分中的贡献，并增强其在 CVD 风险评估、治疗和预防中的作用。