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May 16, 2017

Coronary Artery Calcification Likely the Best Marker of Heart Health

Checking for calcium build-up in the heart’s arteries identifies patients at increased risk for heart disease, finds study.

Checking for calcium build-up in the heart’s arteries is the best way to identify patients at increased risk for heart disease, based on a recent study that compared the top three tests used to predict cardiovascular risk.

Published in the European Heart Journal, this study compared three markers of heart health to see which worked best at predicting cardiovascular risk in healthy adults. These markers included coronary artery calcification (build-up of calcium in the heart’s arteries), carotid-intima-media thickness (thickness of the carotid arteries that supply blood to the brain) and ankle-brachial index (a measure of blood flow in the ankles). All three of these markers can be used to assess heart risk, even in patients with no symptoms of heart disease. However, which tests are most accurate in predicting future heart risks is less clear.

To learn more, researchers analyzed data from the Heinz Nixdorf Recall study, which was conducted in Germany from 2000–2003. The study assessed all three markers of health in more than 3,100 adults that were free of heart disease. Coronary artery calcium and carotid-intima-media thickness were measured using imaging tests, while the ankle-brachial index was assessed using an ultrasound that uses sound waves to assess blood flow.

Researchers followed participants for ten years, tracking outcomes like heart attack, stroke and heart-related death.

Over the ten year period, roughly 7% of participants experienced heart attack, stroke or heart-related death.  After analysis, researchers found that all three tests helped predict patients’ risk of heart events and death. However, coronary artery calcification was most effective at identifying patients at increased risk for heart disease. Authors also note that carotid-intima-media thickness was especially useful in confirming whether a patient was considered low cardiovascular risk.

The take-home message, according to authors, is that all three health tests are useful for estimating cardiovascular risk in patients without symptoms of heart disease. Most importantly, they can help identify patients that should take extra steps to address any cardiovascular risk factors they may have, such as being overweight or having high blood pressure.

However, authors also note that each test has pros and cons, which are important to consider. For example, tests for coronary artery calcification and ankle-brachial index are very reliable, while assessment of the carotid arteries are more prone to measurement errors. On the other hand, CT imaging used to assess coronary artery calcification exposes patients to a low dose of radiation, while the other tests do not.

Authors hope that with future research, we can improve our understanding of these tests and help patients further reduce their risk for heart disease.

Questions for You to Consider

  • What is coronary artery calcification?
  • Coronary artery calcification (CAC) is the buildup of calcium in the arteries, which can cause blood vessels to narrow and lead to the development of heart disease.
  • How is CAC detected?

  • CAC is detected using a special X-ray called a cardiac computed tomography (CT) scan, which can find build-up of calcium on the walls of the arteries. 

Infographic: Heart Attack


Phillip Cartozian is CardioSmart

More than 20 years ago, Phillip Cartozian had two heart attacks and quintuple bypass surgery. Afterward, he changed his diet completely and ate fruit, vegetables and fish every day.

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