Coronary artery calcium score may help personalize blood pressure treatment, guide cardiovascular risk reduction approaches

In a study of more than 6,000 American adults, UAB investigators found that those with a coronary artery calcium score greater than zero have a higher risk of cardiac events. CAC may help guide blood pressure control and comprehensive cardiovascular care.

Heart with coronary vessels inside human body, computer illustration.In a study of more than 6,000 American adults, UAB investigators found that those with a coronary artery calcium score greater than zero have a higher risk of cardiac events. CAC may help guide blood pressure control and comprehensive cardiovascular care.In a recent study published in Hypertension, University of Alabama at Birmingham researchers found that coronary artery calcium score is an excellent predictor of potential cardiovascular events like heart failure, stroke and heart attacks. 

The researchers found that individuals who are not recommended treatment as per the current guidelines may still have a high risk of cardiovascular events, which is captured by their high CAC score. 

Vibhu Parcha, M.D., a clinical research fellow in the Division of Cardiovascular Disease and the first author of this study, explained that the current high blood pressure treatment guidelines by the American Heart Association and the American College of Cardiology define normal blood pressure as clinic blood pressure of less than 120/80 mmHg. 

The guidelines recommend treatment for those with stage I hypertension and high cardiovascular risk and those with stage II hypertension. 

There is a lack of clarity about the cardiovascular risk estimation and treatment approaches among those who are not recommended for treatment and do not have normal blood pressure.  This study aimed to bridge this understanding gap.

Parcha and his investigative team analyzed data from more than 6,000 participants of three large American prospective population cohorts that included the Coronary Artery Risk Development in Young Adults study, the Jackson Heart Study and the Multi-Ethnic Study of Atherosclerosis

The participants in this study underwent a coronary X-ray of the heart to assess their CAC score and were followed up over several years. This allowed the researchers to understand the implications of having an elevated CAC score of more than zero among those across different blood pressure treatment groups.

“We found that, among those who are not currently recommended treatment, a third of them had a CAC greater than zero,” Parcha said. “Furthermore, those with a CAC score greater than zero had a higher risk of developing new-onset coronary heart disease, stroke and heart failure.”  

coronary.3Vibhu Parcha, M.D.Parcha added the bad prognosis among those with CAC greater than zero was seen even among those who are currently not recommended for treatment and are deemed to be at a lower risk.   

“Importantly, this finding was consistent across racial groups,” he said. “If clinicians find a CAC greater than zero in their low-risk hypertensive patients, our study suggests that we should consider initiating blood pressure medications and aggressively pursuing heart-healthy lifestyle habits.” 

By following the data from the study, Parcha says, physicians need to treat fewer people to prevent heart failure, stroke or a coronary heart disease event in those with high blood pressure. 

“Our study findings add to the growing applicability of the power of zero by capturing the risk that is not captured by the ASCVD risk calculator in setting of hypertension,” he said.

Pankaj Arora, M.D., senior author and physician-scientist in the UAB’s Division of Cardiovascular Disease, says there is a growing body of evidence suggesting the role of CAC score is useful for targeting risk-reduction approaches in the population. 

“For those who are not currently recommended treatment for hypertension, the CAC score may be a useful instrument to initiate antihypertensive therapy,” he said. “The findings from our study suggest those with CAC greater than zero can help to further personalize cardiovascular risk when the traditional ASCVD risk calculator gives your hypertensive patient a passing grade. Despite the data, our study does not advocate for universal CAC assessment in patients. The use of CAC score needs to be balanced with a relatively small risk associated with radiation exposure and must be utilized for guiding patient care, in this case initiation of antihypertensive therapy whenever available.”

The UAB Comprehensive Cardiovascular Center provides a broad spectrum of cardiology health care services for people with all types of heart disease in the Southeastern United States. UAB Cardiology has been setting the standards in the field by providing patient care by compassionate, patient-centered and clinically advanced physicians and staff. UAB’s Comprehensive Cardiovascular Center caters to the needs of patients with hypertension, lipid disease, heart failure, stroke and heart attack in Alabama and the surrounding states.