Radiology Cardiothoracic Imaging Podcast | RSNA Episode 7: Coronary Artery Calcium Scoring
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Feb 25, 2021 
Omar Dzaye, radiologist and researcher at Johns Hopkins specializing in coronary calcium imaging. Michael Blaha, preventive cardiology physician-scientist focused on risk stratification. They discuss differences between large retrospective and prospective cohorts, sex and race differences in CAC risk, the meaning of very high CAC and the power of a zero score, CAC on routine chest CTs, and future consortium plans.
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Sex Differences Change CAC Prognosis
- CAC provides sex-specific prognostic differences: women have fewer lesions but larger and denser plaques when present.
- Detectable CAC carried 1.3-fold higher hazard for CV death in women versus men, and density predicted mortality in men but not women.
Race Ethnicity Shape CAC Risk Gradients
- Race and ethnicity modify CAC risk gradients: increased CAC raised CVD and total mortality across groups but with stronger gradients in Blacks and Hispanics.
- These differences persisted even when CAC was zero, indicating residual disparities.
CAC Over 1000 Defines Secondary Prevention–Level Risk
- Extremely high CAC (>1000) identifies a distinct very-high-risk group akin to secondary prevention patients.
- Those with CAC>1000 have greater CAC area, extracoronary calcification, and substantially higher CVD, CHD, cancer, and all-cause mortality than 400–999.