Evaluation of coronary artery calcium progression in asymptomatic individuals with an initial score of zero

Wonjae Lee, Yeonyee E. Yoon, Ohkyung Kwon, Heesun Lee, Hyo Eun Park, Eun Ju Chun, Su Yeon Choi, Goo Yeong Cho, Hyuk Jae Chang

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)


Background and Objectives: Coronary artery calcium (CAC) scoring in the asymptomatic population can improve cardiovascular risk prediction. We aimed to assess CAC progression and the impact of coronary risk factors on the CAC progression rate in asymptomatic Korean individuals with a baseline CAC score of zero. Methods: The study population was derived from the Korea Initiatives on Coronary Artery Calcification (KOICA) registry: a retrospective, single ethnicity, multicenter registry of asymptomatic individuals who underwent CAC scoring as a part of a health checkup. Individuals with at least two CAC scores and an initial score of zero were included. CAC progression was defined as [√CAC score (follow-up) − √CAC score (baseline)] ≥2.5. The 10-year atherosclerotic cardiovascular disease (ASCVD) risk was calculated. Results: Among 6,268 participants (mean age, 48.0±7.1 years; male, 80.5%), 719 (11.5%) experienced CAC progression during follow-up (median, 109 months; interquartile range, 78–208 months). The CAC progression rate was 0.3%, 1.9%, 4.3%, 8.6%, and 16.7% in years 1–5, respectively. The chance of CAC progression at 5 years was 13.1%, 22.0%, and 27.9% for individuals with a 10-year ASCVD risk of 5%, ≥5% but 7.5%, and ≥7.5%, respectively. A multivariable analysis revealed age, male sex, waist circumference, diabetes, and low-density lipoprotein cholesterol level as independently associated with annualized CAC progression (p0.001, p=0.017, p=0.025, p=0.032, and p=0.003, respectively). Conclusions: The probability of CAC progression is very low in Korean individuals with a CAC score of zero. However, the risk of CAC progression increases nonlinearly over time, and increases as the 10-year ASCVD risk increases.

Original languageEnglish
Pages (from-to)448-457
Number of pages10
JournalKorean Circulation Journal
Issue number5
Publication statusPublished - 2019 May

Bibliographical note

Funding Information:
This study was performed with the support of the CardioVascular Research Foundation (CVRF) in the Republic of Korea.

Publisher Copyright:
© 2019. The Korean Society of Cardiology This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Cardiology and Cardiovascular Medicine


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