Comorbidity assessment in patients with a high probability of coronary artery disease with varying coronary calcium scores

Aim. To assess comorbidities in patients with varying coronary calcification who visited a general practitioner.

Material and methods. The study included patients without a confirmed diagnosis of coronary artery disease (CAD) but with its risk factors. All patients underwent a pre-test assessment of CAD probability. The study included a total of 100 patients, in which an Agatston score was assessed using multislice computed tomography (MSCT) and the SmartScore software application. Patients without coronary artery calcification and with an Agatston index <11 were excluded. Of the 59 participants, three following groups were formed: group 1 — coronary calcium score 11- 100 (n=19), group 2 — 101-400 (n=20), group 3 — ≥401 U (n=20).

Results. In the formed groups n=19/20/20, the following were established: mean age (M±m, years): 60,7±1,4; 63,3±1,3; 67,2±1,03, coronary calcification score (M±m, U): 44,8±4,8; 294,4±18,1; 715,8±25,9 and pre-test CAD probability (M±m, %): 16,3±1,3; 17,3±1,2; 21,2±1,8, respectively. There was following distribution of comorbidities in the groups (n/%): chronic obstructive pulmonary disease (COPD): 4/21,1; 3/15,0; 9/45,0; type 2 diabetes (T2D): 7/36,8; 4/20,0; 5/25,0; asthma: 3/15,8; 7/35,0; 3/15,0; no COPD/asthma/T2D: 5/26,3%; 6/30,0%; 3/15,0%, respectively.

Conclusion. When conducting screening measures and assessing the pre-test CAD probability, COPD and asthma should be carefully identified, and, if present, CCS should be studied.

1. Mayorov GB, Kurbanov SK, Vlasova EE, et al. Calcification in coronary heart disease: issues of diagnosis, prognosis and choice of treatment. Russian Cardiology Bulletin. 2018;13(4):4 10. (In Russ.) doi:10.17116/Cardiobulletin2018130414.

2. Bild DE, Bluemke DA, Burke GL, et al. Multi-Ethnic Study of Atherosclerosis: objectives and design. Am J Epidemiol. 2002;156(9):871-81. doi:10.1093/aje/kwf113.

3. Detrano R, Guerci AD, Carr JJ, et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med. 2008;358(13):1336-45. doi:10.1056/NEJMoa072100.

4. Elias-Smale SE, Proença RV, Koller MT, et al. Coronary calcium score improves classification of coronary heart disease risk in the elderly: the Rotterdam study. J Am Coll Cardiol. 2010;56(17):1407-14. doi:10.1016/j.jacc.2010.06.029.

5. Erbel R, Möhlenkamp S, Moebus S, et al. Coronary risk stratification, discrimination, and reclassification improvement based on quantification of subclinical coronary atherosclerosis: the Heinz Nixdorf Recall study. J Am Coll Cardiol. 2010;56(17):1397-406. doi:10.1016/j.jacc.2010.06.0303.

6. Mortensen MB, Dzaye O, Bøtker HE, et al. Low-Density Lipoprotein Cholesterol Is Predominantly Associated With Atherosclerotic Cardiovascular Disease Events in Patients With Evidence of Coronary Atherosclerosis: The Western Denmark Heart Registry. Circulation. 2023;147(14):1053-63. doi:10.1161/CIRCULATIONAHA.122.061010.

7. Blankova ZN, Samsonova NS, Barinova IV, et al. Coronary and aortic calcification in high cardiovascular risk patients with low bone mineral density. Russian Cardiology Bulletin. 2018;13(1):23 9. (In Russ.) doi:10.17116/Cardiobulletin201813123-29.

8. Masenko VL, Kokov AN, Semenov SE, et al. Noninvasive evaluation of density of coronary and carotid calcification in patients with type 2 diabetes mellitus. Journal of radiology and nuclear medicine. 2018;99(6):310-8. (In Russ.) doi:10.20862/0042-4676-2018-99-6-310-318.

9. van der Aalst CM, Denissen SJAM, Vonder M, et al. Screening for cardiovascular disease risk using traditional risk factor assessment or coronary artery calcium scoring: the ROBINSCA trial. Eur Heart J Cardiovasc Imaging. 2020;21(11):1216-24. doi:10.1093/ehjci/jeaa168.

10. Mota IL, Sousa ACS, Almeida MLD, et al. Coronary lesions in patients with COPD (Global Initiative for Obstructive Lung Disease stages I-III) and suspected or confirmed coronary arterial disease. Int J Chron Obstruct Pulmon Dis. 2018;13:1999-2006. doi:10.2147/COPD.S162713.

11. Garg VS, Sojitra MH, Ubhadiya TJ, et al. Understanding the Link Between Adult Asthma and Coronary Artery Disease: A Narrative Review. Cureus. 2023;15(8):e43621. doi:10.7759/cureus.43621.

12. Barbarash OL, Karpov YuA, Panov AV, et al. Stable coronary heart disease. Clinical guidelines 2024. Russian Journal of Cardiology. 2024;29(9):6110. (In Russ.) doi: 10.15829/1560-4071-2024-6110. EDN: HHJJUT.

13. Avdeev SN, Leshchenko IV, Aisanov ZR. Chronic obstructive pulmonary disease (COPD 2024). Clinical guidelines (short version). Respiratory medicine. 2025;1(2): 5-16. (In Russ.)

14. Barbarash OL, Kashtalap VV, Shibanova IA, et al. Fundamental and practical aspects of coronary artery calcification. Russian Journal of Cardiology. 2020;25(S3):4005. (In Russ.). doi:10.15829/1560-4071-2020-4005.

15. Galyavych AS, Khairullin RN, Baleeva LV, et al. Risk Factors of Ischaemic Heart Disease in 419385 Outpatients: a Long-term Comparative Study. Kardiologiia. 2024;64(1):63- 6. (In Russ.) doi:10.18087/cardio.2024.1.n2600.

16. Prakash V, Jaker S, Burgan A, et al. The smoking-dyslipidaemia dyad: A potent synergistic risk for atherosclerotic coronary artery disease. JRSM Cardiovasc Dis. 2021;10:2048004020980945. doi:10.1177/2048004020980945.

17. Clerc OF, Frey SM, Honegger U, et al. Coronary artery calcium score and pre-test probabilities as gatekeepers to predict and rule out perfusion defects in positron emission tomography. J Nucl Cardiol. 2023;30(6):2559-73. doi:10.1007/s12350-023-03322-3.

18. Hou ZH, Lu B, Li ZN, et al. Quantification of atherosclerotic plaque volume in coronary arteries by computed tomographic angiography in subjects with and without diabetes. Chin Med J (Engl). 2020;133(7):773-8. doi:10.1097/CM9.0000000000000733.

19. Doskina EV, Ilyina ES. Osteoporosis and vascular calcification in patients with type 2 diabetes mellitus. Effective pharmacotherapy. 2022;18(41):24-30. (In Russ.) doi:10.33978/2307-3586-2022-18-41-24-30.