Coronary calcium is associated with cardiovascular disease risk.  However, it may not only be the volume, but the density of coronary calcium that influences risk as more dense calcium may reflect stable plaque at lower risk of inciting coronary events.  The traditional Agatson method of scoring coronary calcium burden does not consider coronary calcium volume and density independently. In this prospective cohort study of 3,398 adults without known cardiovascular disease, the authors examined the predictive value of adding coronary calcium density to Agatston volume scores for cardiovascular disease risk. Over a median follow-up of more than 7 years, there were 265 cardiovascular events in the study population and the Agatston volume score of coronary calcium was positively associated with cardiovascular disease risk. However, the density score was inversely associated with cardiovascular disease risk. Furthermore, the addition of the density score improved a risk prediction model for cardiovascular disease.

 Conclusion

Coronary density appears to refine cardiovascular disease risk estimation using coronary calcium scoring, with more dense calcium reflecting stable plaques at lower risk.

•  Criqui MH, Denenberg JO, Ix JH, et al. Calcium density of coronary artery plaque and risk of incident cardiovascular events. JAMA. 2014 Jan 15;311(3):271-8.