Coronary Artery Calcium Scoring Mirvat Alasnag FACP, FRCP, FSCCT, FSCAI, FASE King Fahd Armed Forces Hospital, Jeddah. March 2017

Size: px
Start display at page:

Download "Coronary Artery Calcium Scoring Mirvat Alasnag FACP, FRCP, FSCCT, FSCAI, FASE King Fahd Armed Forces Hospital, Jeddah. March 2017"

Transcription

1 Coronary Artery Calcium Scoring Mirvat Alasnag FACP, FRCP, FSCCT, FSCAI, FASE King Fahd Armed Forces Hospital, Jeddah March 2017

2 Newspapers

3

4 Referrals 62 year old female CT chest and abdomen following an endoscopy for a suspicious mass No cardiac symptoms CAC score moderate Now what? CACS then risk factor modification CACS > 300 ETT or CCTA Arterial calcification on mammography is a predictor >> recommend CAC score

5 1. Younger patients with family history of premature coronary heart disease, have significantly higher CACS.

6 1.

7 2. CAC scoring has consistently been associated with a greater precision than individual and combination of risk factors.

8

9 3. Second hand smoking & pollution from smoking has been associated with increased risk of coronary artery calcification, but not coronary artery disease.

10

11 4. Radiation exposure from a CAC scoring is higher than average annual background radiation in the USA, but less than that for a mammogram.

12

13 5. MESA reports the prevalence of CAC among intermediate risk individuals is 10% and very low risk individuals is 5%.

14

15 MESA SCORE: Multi-Ethnic Study of Atherosclerosis >300 Risk Equivalent (LDL < 70mg/dl) Intermediate <100 Low

16

17 6. CAC scoring is highly predictive of coronary heart disease events across all age groups.

18

19 7. Men tend to have higher levels of calcium than women and the amount of calcium tends to increase with age. This difference is eliminated by age 75.

20

21 8. A CAC score higher than the 50 th percentile for one s age and sex is indicative of high risk clinically significant plaque and premature atherosclerosis.

22

23 9. Patients with a CAC score > 100 were 7-10x more likely to experience a coronary event over a median follow up of 3.9 years.

24

25 10. The value of a CAC score of ZERO has been confirmed in multiple high risk groups.

26

27 11. The annual rate of a coronary event in a patient with a CAC score of 0 is 0.11%.

28 12. A CAC score of 0 translates into a low 10-year risk of coronary heart events irrespective of risk factors.

29

30 13. In Diabetic patients, CAC scoring cannot identify those who are at low risk within this high risk population.

31

32 14. Higher CAC scores have only been associated with coronary heart events and not an increased risk of atrial fibrillation, heart failure or stroke.

33

34 15. CAC scoring is a stronger predictor of cardiovascular disease and coronary heart disease than carotid ultrasound measures.

35

36

37 Controversies with CAC: 1. A positive CAC score does not imply obstructive disease (+ ETT, MPI suggest high likelihood of stenosis ) Often CAC score is referrerd to as a test of atherosclerosis and not stenosis > > risk factor modification 2. CAC score of 0 Over 40 years risk of event/year is <1/1000 Soft plaque is not concerning & event rates higher with mixed or calcified plaque.

38 3. Who to screen for CAC? Low risk with FH of premature CAD, Lupus, HIV Intermediate risk: (5-20%/10 year event rate by 2013 pooled cohort equation) High risk: None >> test won t alter their risk as assessed by other calculators except in statin intolerant 4. De-escalation of therapy for 0 CAC score?

39 Warranty: Normal Coronary angiogram >>10 years CAC score 0 >> 15 years 5 easily 10 probably safe 15 years unless develop in the interim DM/HTN 9715 stratified by age, FRS, NCEP ATP III RESULTS: 4864 CAC 0 >>229 deaths CAC score strongest predictor of death CAC 0 associated with a low vascular age CONCLUSION: Mean follow up 14.6 yrs ( ) A score of 0 confers a 15 year warranty in those at low intermediate risk unaffected by age and sex. High risk w CAC 0 confers better survival than those w lowintermediate risk & any score more than 0.

40

41

42

43 American College of Cardiology Foundation Amir A. Mahabadi et al. JIMG 2017;10:

44 American College of Cardiology Foundation Amir A. Mahabadi et al. JIMG 2017;10:

45

46 5 Trials for Primary Prevention of CVS Disease: 1. DIAD (Diagnostic Imaging in Asymptomatic Diabetics) 2. St Francis Heart Study 3. PACC (Prospective Army Coronary Calcium) 4. EISNER (Early Identification of Subclinical Atherosclerosis by Noninvasive Imaging Research) 5. FACTOR KEEPS -Underpowered -Short follow up

47

Coronary Artery Calcium. Vimal Ramjee, MD FACC The Chattanooga Heart Institute

Coronary Artery Calcium. Vimal Ramjee, MD FACC The Chattanooga Heart Institute Coronary Artery Calcium Vimal Ramjee, MD FACC The Chattanooga Heart Institute Disclosures I have no conflicts of interest to disclose. Objectives Recognize the utility of coronary artery calcium scoring

More information

New Paradigms in Predicting CVD Risk

New Paradigms in Predicting CVD Risk New Paradigms in Predicting CVD Risk Imaging as an Integrator of Lifetime Risk Exposure Michael J. Blaha MD MPH Presented by: Michael J. Blaha September 24, 2014 1 Talk Outline Risk factors vs. Disease

More information

Diagnostic and Prognostic Value of Coronary Ca Score

Diagnostic and Prognostic Value of Coronary Ca Score Diagnostic and Prognostic Value of Coronary Ca Score Dr. Ghormallah Alzahrani Cardiac imaging division, Adult Cardiology department Prince Sultan Cardiac Center ( PSCC) Madina, June 2 Coronary Calcium

More information

Financial Disclosures. Coronary Artery Calcification. Objectives. Coronary Artery Calcium 6/6/2018. Heart Disease Statistics At-a-Glace 2017

Financial Disclosures. Coronary Artery Calcification. Objectives. Coronary Artery Calcium 6/6/2018. Heart Disease Statistics At-a-Glace 2017 Coronary Artery Calcification Dharmendra A. Patel, MD MPH Director, Echocardiography Laboratory Associate Program Director Cardiovascular Disease Fellowship Program Erlanger Heart and Lung Institute UT

More information

Preclinical Detection of CAD: Is it worth the effort? Michael H. Crawford, MD

Preclinical Detection of CAD: Is it worth the effort? Michael H. Crawford, MD Preclinical Detection of CAD: Is it worth the effort? Michael H. Crawford, MD 1 Preclinical? No symptoms No physical findings No diagnostic ECG findings No chest X-ray X findings No diagnostic events 2

More information

Combining Coronary Artery Calcium Scanning with SPECT/PET Myocardial Perfusion Imaging

Combining Coronary Artery Calcium Scanning with SPECT/PET Myocardial Perfusion Imaging Combining Coronary Artery Calcium Scanning with SPECT/PET Myocardial Perfusion Imaging Daniel S. Berman, MD Director, Cardiac Imaging Cedars-Sinai Heart Institute Professor of Medicine and Imaging Cedars-Sinai

More information

Risk Stratification for CAD for the Primary Care Provider

Risk Stratification for CAD for the Primary Care Provider Risk Stratification for CAD for the Primary Care Provider Shimoli Shah MD Assistant Professor of Medicine Directory, Ambulatory Cardiology Clinic Knight Cardiovascular Institute Oregon Health & Sciences

More information

Short and Long Term Prognosis after Coronary Artery Calcium Scoring

Short and Long Term Prognosis after Coronary Artery Calcium Scoring Short and Long Term Prognosis after Coronary Artery Calcium Scoring In Pre-Elderly and Elderly Patients Michael J. Blaha MD MPH Presented by: Michael J. Blaha July 24, 2017 1 Talk Outline 1. Coronary artery

More information

Cardiac CT Angiography

Cardiac CT Angiography Cardiac CT Angiography Dr James Chafey, Radiologist Why do we need a better test for C.A.D? 1. CAD is the leading cause of death in the US CAD 31% Cancer 23% Stroke 7% 2. The prevalence of atherosclerosis

More information

Using Coronary Artery Calcium Score in the Quest for Cardiac Health. Robert J. Hage, D.O.

Using Coronary Artery Calcium Score in the Quest for Cardiac Health. Robert J. Hage, D.O. Using Coronary Artery Calcium Score in the Quest for Cardiac Health Robert J. Hage, D.O. Heart disease is the leading cause of death in the United States in both men and women. About 610,000 people die

More information

Subclinical atherosclerosis in CVD: Risk stratification & management Raul Santos, MD

Subclinical atherosclerosis in CVD: Risk stratification & management Raul Santos, MD Subclinical atherosclerosis in CVD: Risk stratification & management Raul Santos, MD Sao Paulo Medical School Sao Paolo, Brazil Subclinical atherosclerosis in CVD risk: Stratification & management Prof.

More information

2/20/2013. Why use imaging in CV prevention? Update on coronary CTA in 2013 Coronary CTA for 1 0 prevention: pros and cons Are we there yet?

2/20/2013. Why use imaging in CV prevention? Update on coronary CTA in 2013 Coronary CTA for 1 0 prevention: pros and cons Are we there yet? Evolving Role of Coronary CTA in Primary Cardiovascular Disease Prevention: Are We There Yet? Ron Blankstein, M.D., F.A.C.C. Co-Director, Cardiovascular Imaging Training Program Associate Physician, Preventive

More information

Calcium scoring Clinical and prognostic value

Calcium scoring Clinical and prognostic value Calcium scoring Clinical and prognostic value Matthijs Oudkerk Professor and Chair of Radiology University Medical Center Groningen, University of Groningen Groningen, The Netherlands Sofia 2011 13 May

More information

Optimal testing for coronary artery disease in symptomatic and asymptomatic patients

Optimal testing for coronary artery disease in symptomatic and asymptomatic patients Optimal testing for coronary artery disease in symptomatic and asymptomatic patients Alexandre C Ferreira, MD Clinical Chief of Cardiology Jackson Health System Director, Interventional Cardiology Training

More information

MOHAMMED R. ESSOP DIVISION OF CARDIOLOGY CH-BARAGWANATH HOSPITAL

MOHAMMED R. ESSOP DIVISION OF CARDIOLOGY CH-BARAGWANATH HOSPITAL MOHAMMED R. ESSOP DIVISION OF CARDIOLOGY CH-BARAGWANATH HOSPITAL DEFINITION OF A SCREENING TEST TESTING FOR A DISEASE OR CONDITION IN ASYMPTOMATIC PERSONS TO IDENTIFY THE CONDITION BEFORE IT MANIFESTS

More information

The role of coronary artery calcium score on the detection of subclinical atherosclerosis in metabolic diseases

The role of coronary artery calcium score on the detection of subclinical atherosclerosis in metabolic diseases The role of coronary artery calcium score on the detection of subclinical atherosclerosis in metabolic diseases Eun-Jung Rhee Department of Endocrinology and Metabolism Kangbuk Samsung Hospital Sungkyunkwan

More information

CARDIAC IMAGING FOR SUBCLINICAL CAD

CARDIAC IMAGING FOR SUBCLINICAL CAD CARDIAC IMAGING FOR SUBCLINICAL CAD WHY DON'T YOU ADOPT MORE SMART TECHNIQUE? Whal Lee, M.D. Seoul National University Hospital Department of Radiology We are talking about Coronary artery Calcium scoring,

More information

Dr Chris Ellis. Consultant Cardiologist Auckland City Hospital Auckland. 11:30-12:00 ECGs for Nurses, and The Basics of CT Heart Scanning

Dr Chris Ellis. Consultant Cardiologist Auckland City Hospital Auckland. 11:30-12:00 ECGs for Nurses, and The Basics of CT Heart Scanning Dr Chris Ellis Consultant Cardiologist Auckland City Hospital Auckland 11:30-12:00 ECGs for Nurses, and The Basics of CT Heart Scanning ECGs for Nurses, and the Basics of CT Heart Scanning Dr Chris Ellis

More information

Landmesser U et al. Eur Heart J 2017; https://doi.org/ /eurheartj/ehx549

Landmesser U et al. Eur Heart J 2017; https://doi.org/ /eurheartj/ehx549 2017 Update of ESC/EAS Task Force on Practical Clinical Guidance for PCSK9 inhibition in Patients with Atherosclerotic Cardiovascular Disease or in Familial Hypercholesterolaemia Cardiovascular Outcomes

More information

The International SHAPE Accreditation and Early Detection Program Report

The International SHAPE Accreditation and Early Detection Program Report The International SHAPE Accreditation and Early Detection Program 2012-2014 Report Jeffrey Fine MS, PhD Introduction The implementation of a guideline based early detection program using coronary calcium

More information

Khurram Nasir, MD MPH

Khurram Nasir, MD MPH Non-invasive CAD Screening Khurram Nasir, MD MPH Disclosures I have no relevant commercial relationships to disclose, and my presentation will not include off label or unapproved usage. HOW & WHAT WOULD

More information

Cardiac CT for Risk Assessment: Do we need to look beyond Coronary Artery Calcification

Cardiac CT for Risk Assessment: Do we need to look beyond Coronary Artery Calcification Cardiac CT for Risk Assessment: Do we need to look beyond Coronary Artery Calcification Matthew Budoff, MD, FACC, FAHA Professor of Medicine Director, Cardiac CT Harbor-UCLA Medical Center, Torrance, CA

More information

The role of coronary artery calcium score on the detection of subclinical atherosclerosis in metabolic diseases

The role of coronary artery calcium score on the detection of subclinical atherosclerosis in metabolic diseases The role of coronary artery calcium score on the detection of subclinical atherosclerosis in metabolic diseases Eun-Jung Rhee Department of Endocrinology and Metabolis Kangbuk Samsung Hospital Sungkyunkwan

More information

Dr Chris Ellis. Consultant Cardiologist Auckland

Dr Chris Ellis. Consultant Cardiologist Auckland Dr Chris Ellis Consultant Cardiologist Auckland CVD Risk Prevention in NZ 2013 & Beyond: The Clinicians View Dr Chris Ellis Cardiologist Green Lane CVS Service, Cardiology Department, Auckland City Hospital

More information

Potential recommendations for CT coronary angiography in athletes

Potential recommendations for CT coronary angiography in athletes Potential recommendations for CT coronary angiography in athletes B.K. Velthuis Dept. of Radiology UMC Utrecht, the Netherlands EuroPRevent 15 April 2011 Declaration of interest Philips Medical Systems

More information

Coronary Artery Calcification

Coronary Artery Calcification Coronary Artery Calcification Julianna M. Czum, MD OBJECTIVES CORONARY ARTERY CALCIFICATION Julianna M. Czum, MD Dartmouth-Hitchcock Medical Center 1. To review the clinical significance of coronary heart

More information

Sanger Heart & Vascular Institute Symposium 2015

Sanger Heart & Vascular Institute Symposium 2015 Sanger Heart & Vascular Institute Symposium 2015 Cardiovascular Update For Primary Care Physicians William E. Downey, MD FACC FSCAI Medical Director, Interventional Cardiology Sanger Heart & Vascular Institute

More information

ACC/AHA GUIDELINES ON LIPIDS AND PCSK9 INHIBITORS

ACC/AHA GUIDELINES ON LIPIDS AND PCSK9 INHIBITORS ACC/AHA GUIDELINES ON LIPIDS AND PCSK9 INHIBITORS Ziyad Ghazzal MD, FACC, FSCAI Professor of Medicine Deputy Vice President/Dean Associate Dean for Clinical Affairs American University of Beirut Adjunct

More information

Management of Stable Ischemic Heart Disease. Vinay Madan MD February 10, 2018

Management of Stable Ischemic Heart Disease. Vinay Madan MD February 10, 2018 Management of Stable Ischemic Heart Disease Vinay Madan MD February 10, 2018 1 Disclosure No financial disclosure. 2 Overview of SIHD Diagnosis Outline of talk Functional vs. Anatomic assessment Management

More information

LDL cholesterol (p = 0.40). However, higher levels of HDL cholesterol (> or =1.5 mmol/l [60 mg/dl]) were associated with less progression of CAC

LDL cholesterol (p = 0.40). However, higher levels of HDL cholesterol (> or =1.5 mmol/l [60 mg/dl]) were associated with less progression of CAC Am J Cardiol (2004);94:729-32 Relation of degree of physical activity to coronary artery calcium score in asymptomatic individuals with multiple metabolic risk factors M. Y. Desai, et al. Ciccarone Preventive

More information

Current Cholesterol Guidelines and Treatment of Residual Risk COPYRIGHT. J. Peter Oettgen, MD

Current Cholesterol Guidelines and Treatment of Residual Risk COPYRIGHT. J. Peter Oettgen, MD Current Cholesterol Guidelines and Treatment of Residual Risk J. Peter Oettgen, MD Associate Professor of Medicine Harvard Medical School Director, Preventive Cardiology Beth Israel Deaconess Medical Center

More information

NEW GUIDELINES FOR CHOLESTEROL

NEW GUIDELINES FOR CHOLESTEROL NEW GUIDELINES FOR CHOLESTEROL NEW CHOLESTEROL GUIDELINES 2013 Recently updated guidelines for the treatment of high blood cholesterol levels is a major update since 2002. The news media have trumpeted

More information

MEDICAL POLICY SUBJECT: CORONARY CALCIUM SCORING

MEDICAL POLICY SUBJECT: CORONARY CALCIUM SCORING MEDICAL POLICY PAGE: 1 OF: 5 If the member's subscriber contract excludes coverage for a specific service it is not covered under that contract. In such cases, medical policy criteria are not applied.

More information

Current and Future Imaging Trends in Risk Stratification for CAD

Current and Future Imaging Trends in Risk Stratification for CAD Current and Future Imaging Trends in Risk Stratification for CAD Brian P. Griffin, MD FACC Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Disclosures: None Introduction

More information

Treatment of Cardiovascular Risk Factors. Kevin M Hayes D.O. F.A.C.C. First Coast Heart and Vascular Center

Treatment of Cardiovascular Risk Factors. Kevin M Hayes D.O. F.A.C.C. First Coast Heart and Vascular Center Treatment of Cardiovascular Risk Factors Kevin M Hayes D.O. F.A.C.C. First Coast Heart and Vascular Center Disclosures: None Objectives What do risk factors tell us What to check and when Does treatment

More information

MD F A F C A C MAS A N S C

MD F A F C A C MAS A N S C Myocardial Perfusion Imaging and Coronary Calcium Scoring: Complimentary or Competitive David Wolinsky MD FACC MASNC Section Head Nuclear Cardiology, Cleveland Clinic Florida Immediate Past President,

More information

MPS and Calcium Score in asymptomatic patient F. Mut, J. Vitola

MPS and Calcium Score in asymptomatic patient F. Mut, J. Vitola MPS and Calcium Score in asymptomatic patient F. Mut, J. Vitola Nuclear Medicine Service, Asociacion Española Montevideo, Uruguay Quanta Diagnostico Nuclear Curitiba, Brazil Clinical history Male 63 y.o.,

More information

BENEFIT APPLICATION BLUECARD/NATIONAL ACCOUNT ISSUES

BENEFIT APPLICATION BLUECARD/NATIONAL ACCOUNT ISSUES Medical Policy Medical Policy MP 6.01.03 BCBSA Ref. Policy: 6.01.03 Last Review: 09/19/2018 Effective Date: 09/19/2018 Section: Medicine Related Policies 9.01.502 Experimental / Investigational Services

More information

Prevention of Heart Disease: The New Guidelines

Prevention of Heart Disease: The New Guidelines Prevention of Heart Disease: The New Guidelines Nisha I. Parikh MD MPH Assistant Professor of Medicine Division of Cardiology Department of Medicine University of California San Francisco May 18 th 2015

More information

Physical Activity and Coronary calcification ADJ ASSOCIATE PROFESSOR TAN SWEE YAW NATIONAL HEART CENTRE SINGAPORE

Physical Activity and Coronary calcification ADJ ASSOCIATE PROFESSOR TAN SWEE YAW NATIONAL HEART CENTRE SINGAPORE Physical Activity and Coronary calcification ADJ ASSOCIATE PROFESSOR TAN SWEE YAW NATIONAL HEART CENTRE SINGAPORE Calcium Scores (CACS) Calcium Scores (CACS) Calcium Scores are indicative of the presence

More information

Diabetes and Occult Coronary Artery Disease

Diabetes and Occult Coronary Artery Disease Diabetes and Occult Coronary Artery Disease Mun K. Hong, MD, FACC, FSCAI Director, Cardiac Catheterization Laboratory & Interventional Cardiology St. Luke s-roosevelt Hospital Center New York, New York

More information

New Guidelines in Dyslipidemia Management

New Guidelines in Dyslipidemia Management The Fourth IAS-OSLA Course on Lipid Metabolism and Cardiovascular Risk Muscat, Oman, February 2018 New Guidelines in Dyslipidemia Management Dr. Khalid Al-Waili, MD, FRCPC, DABCL Senior Consultant Medical

More information

The Multiethnic Study of Atherosclerosis (MESA) Cardiovascular Risk in Hispanics

The Multiethnic Study of Atherosclerosis (MESA) Cardiovascular Risk in Hispanics The Multiethnic Study of Atherosclerosis (MESA) Cardiovascular Risk in Hispanics Michael H. Criqui MD, MPH Distinguished Professor and Chief, Division of Preventive Medicine Department of Family and Preventive

More information

Testing the Asymptomatic CAD Patient: When and Why?

Testing the Asymptomatic CAD Patient: When and Why? Testing the Asymptomatic CAD Patient: When and Why? Timothy M. Bateman M.D. Co-Director, Cardiovascular Radiologic Imaging Mid America Heart Institute Professor of Medicine University of Missouri-Kansas

More information

CVD Risk Assessment. Michal Vrablík Charles University, Prague Czech Republic

CVD Risk Assessment. Michal Vrablík Charles University, Prague Czech Republic CVD Risk Assessment Michal Vrablík Charles University, Prague Czech Republic What is Risk? A cumulative probability of an event, usually expressed as percentage e.g.: 5 CV events in 00 pts = 5% risk This

More information

Are We Ready for a Paradigm Shift From Risk Factors to Detection of Subclinical Coronary Atherosclerosis? Lessons From MESA. Khurram Nasir, MD MPH

Are We Ready for a Paradigm Shift From Risk Factors to Detection of Subclinical Coronary Atherosclerosis? Lessons From MESA. Khurram Nasir, MD MPH Are We Ready for a Paradigm Shift From Risk Factors to Detection of Subclinical Coronary Atherosclerosis? Lessons From MESA Khurram Nasir, MD MPH Disclosures No disclosures. Burden of Cardiovascular Disease

More information

Εξελίξεις και νέες προοπτικές στην καρδιαγγειακή απεικόνιση CT. Σταμάτης Κυρζόπουλος Ωνάσειο Καρδιοχειρουργικό Κέντρο

Εξελίξεις και νέες προοπτικές στην καρδιαγγειακή απεικόνιση CT. Σταμάτης Κυρζόπουλος Ωνάσειο Καρδιοχειρουργικό Κέντρο Εξελίξεις και νέες προοπτικές στην καρδιαγγειακή απεικόνιση CT Σταμάτης Κυρζόπουλος Ωνάσειο Καρδιοχειρουργικό Κέντρο No conflict of interest to disclose Noninvasive Cardiac Imaging Unresolved Issues-Future

More information

How to Reduce Residual Risk in Primary Prevention

How to Reduce Residual Risk in Primary Prevention How to Reduce Residual Risk in Primary Prevention Helene Glassberg, MD Assistant Professor of Medicine Section of Cardiology Hospital of the University of Pennsylvania Philadelphia, PA USA Patients with

More information

Richard Grocott Mason

Richard Grocott Mason Richard Grocott Mason What to do with a 50 year old man with chest pain? Does the pain sound cardiac? Is this a possible acute coronary syndrome? Does patient have a previous cardiac history? Natural history

More information

1. Which one of the following patients does not need to be screened for hyperlipidemia:

1. Which one of the following patients does not need to be screened for hyperlipidemia: Questions: 1. Which one of the following patients does not need to be screened for hyperlipidemia: a) Diabetes mellitus b) Hypertension c) Family history of premature coronary disease (first degree relatives:

More information

MEDICAL POLICY. 02/15/18 CATEGORY: Technology Assessment

MEDICAL POLICY. 02/15/18 CATEGORY: Technology Assessment MEDICAL POLICY SUBJECT: CORONARY CALCIUM SCORING PAGE: 1 OF: 5 If a product excludes coverage for a service, it is not covered, and medical policy criteria do not apply. If a commercial product, including

More information

FFR-CT Not Ready for Primetime

FFR-CT Not Ready for Primetime FFR-CT Not Ready for Primetime Leslee J. Shaw, PhD, MASNC, FACC, FAHA, FSCCT R. Bruce Logue Professor of Medicine Co-Director, Emory Clinical CV Research Institute Emory University School of Medicine Atlanta,

More information

David Ramenofsky, MD Bryan Kestenbaum, MD

David Ramenofsky, MD Bryan Kestenbaum, MD Association of Serum Phosphate Concentration with Vascular Calcification in Patients Free of Chronic Kidney Disease: The Multi Ethnic Study of Atherosclerosis David Ramenofsky, MD Bryan Kestenbaum, MD

More information

Assessing atherosclerotic risk for long term preventive treatment

Assessing atherosclerotic risk for long term preventive treatment Assessing atherosclerotic risk for long term preventive treatment Donald A. Smith, MD, MPH Endocrinologist, Clinical Lipidologist Associate Professor of Medicine and Preventive Medicine Icahn School of

More information

Screening for Cardiovascular Risk (2/6/09)

Screening for Cardiovascular Risk (2/6/09) Screening for Cardiovascular Risk (2/6/09) Andrew Nicolaides MS, FRCS, FRCSE, PhD (Hon) Emeritus Professor of Vascular Surgery, Imperial College, London, UK Chairman, Cardiovascular Disease Educational

More information

What s new in cardiovascular disease risk assessment and management for primary care clinicians

What s new in cardiovascular disease risk assessment and management for primary care clinicians Cardiovascular system What s new in cardiovascular disease risk assessment and management for primary care clinicians The recently released 2018 Cardiovascular Disease Risk Assessment and Management for

More information

I have no financial disclosures

I have no financial disclosures Manpreet Singh MD I have no financial disclosures Exercise Treadmill Bicycle Functional capacity assessment Well validated prognostic value Ischemic assessment ECG changes ST segments Arrhythmias Hemodynamic

More information

The presenter does not have any potential conflicts of interest to disclose

The presenter does not have any potential conflicts of interest to disclose Carotid intima-media thickness as a predictor of multi territory atherosclerotic occlusive disease in patients with symptomatic subclavian artery obstruction Leszek Wrotniak 1, Anna Kabłak Ziembicka 1,

More information

Disclosures. Prevention of Heart Disease: The New Guidelines. Summary of Talk. Four guidelines. No relevant disclosures.

Disclosures. Prevention of Heart Disease: The New Guidelines. Summary of Talk. Four guidelines. No relevant disclosures. Disclosures Prevention of Heart Disease: The New Guidelines No relevant disclosures Nisha I. Parikh MD MPH Assistant Professor of Medicine Division of Cardiology Department of Medicine University of California

More information

Vascular calcification in patients with Diabetes Mellitus. Dr Jamie Bellinge University of Western Australia Royal Perth Hospital

Vascular calcification in patients with Diabetes Mellitus. Dr Jamie Bellinge University of Western Australia Royal Perth Hospital Vascular calcification in patients with Diabetes Mellitus Dr Jamie Bellinge University of Western Australia Royal Perth Hospital Risk of cardiovascular disease Cardiovascular disease; - Stroke - Coronary

More information

SCAPIS. Swedish CArdioPulmonary BioImage Study. SCAPIS outline. one of the largest cardiopulmonary research programs in Sweden

SCAPIS. Swedish CArdioPulmonary BioImage Study. SCAPIS outline. one of the largest cardiopulmonary research programs in Sweden SCAPIS Swedish CArdioPulmonary BioImage Study one of the largest cardiopulmonary research programs in Sweden SCAPIS outline Identification of vulnerable plaques CTA Ultrasound (carotid artery) MRI (carotid

More information

Who Cares About the Past?

Who Cares About the Past? Risk Factors, the New Calcium Score, Rheology and Atherosclerosis Progression Arthur Agatston 2/21/15 The Vulnerable Plaque vs. Plaque Burden CT Angiogram Is There a Role for Coronary Artery Calcium Scoring

More information

Report For Center Created Gender D.O.B Page 1 Sean Breen HeartSmart IMT plus 3/29/2012 Male 11/26/1973 B C D E

Report For Center Created Gender D.O.B Page 1 Sean Breen HeartSmart IMT plus 3/29/2012 Male 11/26/1973 B C D E Report For Center Created Gender D.O.B Page 1 Carotid Assessment A B C D E Good Satisfactory Concern Serious Highest Risk Intima-Media Thickness Additional Findings Plaque Character Percent Stenosis Comments:

More information

Conceptual Approach to CAD Risk. Disclosures. Integrating Imaging and Biomarkers for Optimal CVD Risk Assessment and Management 2/10/2014.

Conceptual Approach to CAD Risk. Disclosures. Integrating Imaging and Biomarkers for Optimal CVD Risk Assessment and Management 2/10/2014. Integrating Imaging and Biomarkers for Optimal CVD Risk Assessment and Management None Disclosures Arthur Agatston Conceptual Approach to CAD Risk Devereux Circulation, 1993 1 Age Obesity Family Hx Diabetes

More information

Vascular disease. Structural evaluation of vascular disease. Goo-Yeong Cho, MD, PhD Seoul National University Bundang Hospital

Vascular disease. Structural evaluation of vascular disease. Goo-Yeong Cho, MD, PhD Seoul National University Bundang Hospital Vascular disease. Structural evaluation of vascular disease Goo-Yeong Cho, MD, PhD Seoul National University Bundang Hospital resistance vessels : arteries

More information

Atherosclerotic Disease Risk Score

Atherosclerotic Disease Risk Score Atherosclerotic Disease Risk Score Kavita Sharma, MD, FACC Diplomate, American Board of Clinical Lipidology Director of Prevention, Cardiac Rehabilitation and the Lipid Management Clinics September 16,

More information

Lifetime clinical and economic benefits of statin-based LDL lowering in the 20-year Followup of the West of Scotland Coronary Prevention Study

Lifetime clinical and economic benefits of statin-based LDL lowering in the 20-year Followup of the West of Scotland Coronary Prevention Study Lifetime clinical and economic benefits of statin-based LDL lowering in the 20-year Followup of the West of Scotland Coronary Prevention Study Harvey White Green Lane Cardiovascular Service and Cardiovascular

More information

CLINICAL STUDY. Yasser Khalil, MD; Bertrand Mukete, MD; Michael J. Durkin, MD; June Coccia, MS, RVT; Martin E. Matsumura, MD

CLINICAL STUDY. Yasser Khalil, MD; Bertrand Mukete, MD; Michael J. Durkin, MD; June Coccia, MS, RVT; Martin E. Matsumura, MD 117 CLINICAL STUDY A Comparison of Assessment of Coronary Calcium vs Carotid Intima Media Thickness for Determination of Vascular Age and Adjustment of the Framingham Risk Score Yasser Khalil, MD; Bertrand

More information

Η Πυρηνική Καρδιολογία Το 2017 ΟΜΑΔΑ ΕΡΓΑΣΙΑΣ ΑΠΕΙΚΟΝΙΣΤΙΚΩΝ ΤΕΧΝΙΚΩΝ

Η Πυρηνική Καρδιολογία Το 2017 ΟΜΑΔΑ ΕΡΓΑΣΙΑΣ ΑΠΕΙΚΟΝΙΣΤΙΚΩΝ ΤΕΧΝΙΚΩΝ Η Πυρηνική Καρδιολογία Το 2017 ΟΜΑΔΑ ΕΡΓΑΣΙΑΣ ΑΠΕΙΚΟΝΙΣΤΙΚΩΝ ΤΕΧΝΙΚΩΝ huma human n Setting diagnosis of the early stages of chronic diseases (i.e cancer, neuropsychiatric, cardiovascular disorders), in

More information

Carotid Ultrasound Scans for Assessing Cardiovascular Risk

Carotid Ultrasound Scans for Assessing Cardiovascular Risk Transcript Details This is a transcript of an educational program accessible on the ReachMD network. Details about the program and additional media formats for the program are accessible by visiting: https://reachmd.com/programs/lipid-luminations/carotid-ultrasound-scans-for-assessing-cardiovascularrisk/4004/

More information

Long-Term Complications of Diabetes Mellitus Macrovascular Complication

Long-Term Complications of Diabetes Mellitus Macrovascular Complication Long-Term Complications of Diabetes Mellitus Macrovascular Complication Sung Hee Choi MD, PhD Professor, Seoul National University College of Medicine, SNUBH, Bundang Hospital Diabetes = CVD equivalent

More information

Carotid Ddisease, Carotid IMT and Risk of Stroke

Carotid Ddisease, Carotid IMT and Risk of Stroke Carotid Ddisease, Carotid IMT and Risk of Stroke TATJANA RUNDEK, MD PhD Professor of Neurology, Epidemiology and Public Health Director, Clinical translational Division Department of Neurology, Miller

More information

ACCF/AHA Expert Consensus Document

ACCF/AHA Expert Consensus Document ACCF/AHA Expert Consensus Document ACCF/AHA 2007 Clinical Expert Consensus Document on Coronary Artery Calcium Scoring by Computed Tomography in Global Cardiovascular Risk Assessment and in Evaluation

More information

Polish Your Practice Heart Failure. Why Prevent Vs. Treat? Coronary Heart Disease. A Challenging Patient:1994. Risk Factors for Heart Attack

Polish Your Practice Heart Failure. Why Prevent Vs. Treat? Coronary Heart Disease. A Challenging Patient:1994. Risk Factors for Heart Attack Polish Your Practice Heart Failure Lipid Management for the Prevention of Coronary Heart Disease in 2008 Carl E. Orringer, MD, FACC Clinical Associate Professor of Medicine Case Western Reserve University

More information

Beyond Framingham. Prediction of cardiovascular risk. Niels van Pelt Cardiologist, Middlemore Hospital

Beyond Framingham. Prediction of cardiovascular risk. Niels van Pelt Cardiologist, Middlemore Hospital Beyond Framingham Prediction of cardiovascular risk Niels van Pelt Cardiologist, Middlemore Hospital Niels Bohr (Danish Physicist)1885-1962 Prediction is very difficult, especially if it's about the future

More information

To Do or Not To Do? The Annual Physical- Beyond The PAP And Breast Exam

To Do or Not To Do? The Annual Physical- Beyond The PAP And Breast Exam 1/27/2015 To Do or Not To Do? The Annual Physical- Beyond The PAP And Breast Exam Fleur Sack, M.D., FAAFP Society of General Internal Medicine Cochrane review of 182,000 people followed for 9 years : the

More information

Coronary Artery Calcium: Absence Makes the Heart Younger?

Coronary Artery Calcium: Absence Makes the Heart Younger? Coronary Artery Calcium: Absence Makes the Heart Younger? Parag H. Joshi, MD, MHS, FACC Assistant Professor of Medicine Division of Cardiology University of Texas Southwestern Medical Center Department

More information

No relevant financial relationships

No relevant financial relationships MANAGEMENT OF LIPID DISORDERS Balancing Benefits and harms Disclosure Robert B. Baron, MD MS Professor and Associate Dean UCSF School of Medicine No relevant financial relationships baron@medicine.ucsf.edu

More information

American Osteopathic College of Occupational and Preventive Medicine 2012 Mid-Year Educational Conference St. Petersburg, Florida

American Osteopathic College of Occupational and Preventive Medicine 2012 Mid-Year Educational Conference St. Petersburg, Florida The 21 st Century Paradigm Shift: Prevention Rather Than Intervention for the Treatment of Stable CHD The Economic Burden of Cardiovascular Diseases Basil Margolis MD, FACC, FRCP Director, Preventive Cardiology

More information

How would you manage Ms. Gold

How would you manage Ms. Gold How would you manage Ms. Gold 32 yo Asian woman with dyslipidemia Current medications: Simvastatin 20mg QD Most recent lipid profile: TC = 246, TG = 100, LDL = 176, HDL = 50 What about Mr. Williams? 56

More information

CORONARY ARTERY CALCIUM AND INCIDENT STROKE IN THE MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS (MESA) COHORT ASHLEIGH A. OWEN, MD

CORONARY ARTERY CALCIUM AND INCIDENT STROKE IN THE MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS (MESA) COHORT ASHLEIGH A. OWEN, MD CORONARY ARTERY CALCIUM AND INCIDENT STROKE IN THE MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS (MESA) COHORT BY ASHLEIGH A. OWEN, MD A Thesis Submitted to the Graduate Faculty of WAKE FOREST UNIVERSITY GRADUATE

More information

Review of guidelines for management of dyslipidemia in diabetic patients

Review of guidelines for management of dyslipidemia in diabetic patients 2012 international Conference on Diabetes and metabolism (ICDM) Review of guidelines for management of dyslipidemia in diabetic patients Nan Hee Kim, MD, PhD Department of Internal Medicine, Korea University

More information

Is computed tomography angiography really useful in. of coronary artery disease?

Is computed tomography angiography really useful in. of coronary artery disease? Is computed tomography angiography really useful in screening patients with high risk of coronary artery disease? Myeong-Ki Hong, M.D. Ph D Professor of Medicine Division of Cardiology, Severance Cardiovascular

More information

Role of Nonenhanced Multidetector CT Coronary Artery Calcium Testing in Asymptomatic and Symptomatic Individuals 1

Role of Nonenhanced Multidetector CT Coronary Artery Calcium Testing in Asymptomatic and Symptomatic Individuals 1 Note: This copy is for your personal non-commercial use only. To order presentation-ready copies for distribution to your colleagues or clients, contact us at www.rsna.org/rsnarights. Role of Nonenhanced

More information

Keywords Coronary artery calcium Coronary artery atherosclerosis Coronary risk assessment Coronary artery CT

Keywords Coronary artery calcium Coronary artery atherosclerosis Coronary risk assessment Coronary artery CT Int J Cardiovasc Imaging (2008) 24:645 671 DOI 10.1007/s10554-008-9319-z ORIGINAL PAPER Coronary artery calcium screening: current status and recommendations from the European Society of Cardiac Radiology

More information

Imaging of Coronary Arteries Aid in Prevention of Atherosclerosis and Clinical Coronary Heart Disease

Imaging of Coronary Arteries Aid in Prevention of Atherosclerosis and Clinical Coronary Heart Disease 152 The Open Epidemiology Journal, 2011, 4, 152-164 Open Access Imaging of Coronary Arteries Aid in Prevention of Atherosclerosis and Clinical Coronary Heart Disease Lewis H. Kuller *, 1 and Daniel Edmundowicz

More information

Coronary Calcium Predicts Events Better With Absolute Calcium Scores Than Age-Sex-Race/Ethnicity Percentiles

Coronary Calcium Predicts Events Better With Absolute Calcium Scores Than Age-Sex-Race/Ethnicity Percentiles Journal of the American College of Cardiology Vol. 53, No. 4, 2009 2009 by the American College of Cardiology Foundation ISSN 0735-1097/09/$36.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2008.07.072

More information

When Should I Order a Stress Test or an Echocardiogram

When Should I Order a Stress Test or an Echocardiogram When Should I Order a Stress Test or an Echocardiogram Updates in Cardiology 2015 March 7, 2015 Donald L. Lappé, MD, FAHA, FACC Chairman, Cardiovascular Department Medical Director, Intermountain Cardiovascular

More information

2013 ACC/AHA Guidelines on the Assessment of Atherosclerotic Cardiovascular Risk: Overview and Commentary

2013 ACC/AHA Guidelines on the Assessment of Atherosclerotic Cardiovascular Risk: Overview and Commentary 2013 ACC/AHA Guidelines on the Assessment of Atherosclerotic Cardiovascular Risk: Overview and Commentary The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease Becky McKibben, MPH; Seth

More information

Cardiovascular risk assessment in patients with diabetes

Cardiovascular risk assessment in patients with diabetes DOI 10.1186/s13098-017-0225-1 Diabetology & Metabolic Syndrome REVIEW Open Access Cardiovascular risk assessment in patients with diabetes Marcello Casaccia Bertoluci 1,2,3* and Viviane Zorzanelli Rocha

More information

Prevention of MACROvascular Complications of Diabetes

Prevention of MACROvascular Complications of Diabetes Prevention of MACROvascular Complications of Diabetes Matt Bouchonville, MD, CDE Endocrinology Division University of New Mexico School of Medicine July 12, 2018 Conflicts of Interest None Objectives 1.

More information

Screening for Asymptomatic Coronary Artery Disease: When, How, and Why?

Screening for Asymptomatic Coronary Artery Disease: When, How, and Why? Screening for Asymptomatic Coronary Artery Disease: When, How, and Why? Joseph S. Terlato, MD FACC Clinical Assistant Professor, Brown Medical School Coastal Medical Definition The presence of objective

More information

CARDIOMETABOLIC SYNDROME

CARDIOMETABOLIC SYNDROME CARDIOMETABOLIC SYNDROME Prof. Gerald Yonga FESC, FACC Dept of Medicine, Aga Khan University East Africa Introduction Years after the term metabolic syndrome was first coined, controversy continues over

More information

Update on Lipid Management in Cardiovascular Disease: How to Understand and Implement the New ACC/AHA Guidelines

Update on Lipid Management in Cardiovascular Disease: How to Understand and Implement the New ACC/AHA Guidelines Update on Lipid Management in Cardiovascular Disease: How to Understand and Implement the New ACC/AHA Guidelines Paul Mahoney, MD Sentara Cardiology Specialists Lipid Management in Cardiovascular Disease

More information

Review current guideline recommendations for lipid-lowering therapy

Review current guideline recommendations for lipid-lowering therapy Breakout Session #3 New Paradigms in the Management of Dyslipidemia Review current guideline recommendations for lipid-lowering therapy Dr Meral KAYIKCIOGLU Ege University Medical School, Cardiology Dept,

More information

Dr Chris Ellis Cardiologist, Auckland City Hospital

Dr Chris Ellis Cardiologist, Auckland City Hospital Dr Chris Ellis Cardiologist, Auckland City Hospital CT Cardiac Angiography: Clinical Use Dr Chris Ellis Cardiologist Greenlane CVS Services Auckland City Hospital & Auckland Heart Group: Mercy Hospital

More information

Calcium Scoring and Cardiac CT

Calcium Scoring and Cardiac CT Calcium Scoring and Cardiac CT John C. Finley, MD, FACC, FASE Medical Director, CT Department; Alaska Heart and Vascular Institute February 9, 2018 1. Calcium Scoring 2. CT Coronary Angiography 3. Use

More information

Treatment Considerations for Carotid Artery Stenosis. Danielle Zielinski, RN, MSN, ACNP Rush University Neurosurgery

Treatment Considerations for Carotid Artery Stenosis. Danielle Zielinski, RN, MSN, ACNP Rush University Neurosurgery Treatment Considerations for Carotid Artery Stenosis Danielle Zielinski, RN, MSN, ACNP Rush University Neurosurgery 4.29.2016 There is no actual or potential conflict of interest in regards to this presentation

More information

CT Imaging of Atherosclerotic Plaque. William Stanford MD Professor-Emeritus Radiology University of Iowa College of Medicine Iowa City, IA

CT Imaging of Atherosclerotic Plaque. William Stanford MD Professor-Emeritus Radiology University of Iowa College of Medicine Iowa City, IA CT Imaging of Atherosclerotic Plaque William Stanford MD Professor-Emeritus Radiology University of Iowa College of Medicine Iowa City, IA PREVALENCE OF CARDIOVASCULAR DISEASE In 2006 there were 80 million

More information

Dr Joan Leighton. Professor Gerry Devlin. 14:00-14:55 WS #106: Whats Topical in Cardiology 15:05-16:00 WS #116: Whats Topical in Cardiology (Repeated)

Dr Joan Leighton. Professor Gerry Devlin. 14:00-14:55 WS #106: Whats Topical in Cardiology 15:05-16:00 WS #116: Whats Topical in Cardiology (Repeated) Professor Gerry Devlin Clinical Cardiologist and Interventional Cardiologist NZ Heart Foundation Hamilton Dr Joan Leighton General Practitioner Heart Foundation Christchurch 14:00-14:55 WS #106: Whats

More information