Co esponding au ho : Umma ah Kam an
Copy igh © 2025 Au ho (s) e ain he copy igh o his a icle. This a icle is published unde he e ms o he C ea i e Commons A ibu ion Liscense 4.0.
Agas a on co ona y a e y calcium sco e dis ibu ion by age and gende among 20-
80 yea s old pa ien s—da a om a single cen e in Pakis an
Umma ah Kam an 1, *, Im an I ikha 2, Misbah Du ani 1, Anum Yousa 1, Naila Ahmed 1, Adeel u Rehman 2
and Ma yam Kam an 3
1 Depa men o Radiology, Rawalpindi Ins i u e o Ca diology, Pakis an.
2 Depa men o Ca diology, Rawalpindi Ins i u e o Ca diology, Pakis an.
3 Depa men o Ca diology, Punjab Ins i u e o Ca diology, Pakis an.
Wo ld Jou nal o Biology Pha macy and Heal h Sciences, 2025, 21(01), 343-349
Publica ion his o y: Recei ed on 30 No embe 2024; e ised on 11 Janua y 2025; accep ed on 13 Janua y 2025
A icle DOI: h ps://doi.o g/10.30574/wjbphs.2025.21.1.0031
Abs ac
Pu pose: Co ona y a e y calcium (CAC) is an es ima e o a he oscle o ic bu den and well- alida ed o isk assessmen
in middle o olde aged adul s. The co ona y a e y calcium (CAC) sco e is used in decision making o p e en i e
medica ions in pa ien s wi h bo de line clinical isk sco es. This s udy will be aluable addi ion o esea ch da a base
as no such s udy has been conduc ed in ou cen e o da e.
Me hods: A e ospec i e s udy was conduc ed a Rawalpindi ins i u e o ca diology and da abase was sc eened o
pa ien s who unde wen CT ca diac angiog aphy and calcium sco e assessmen be ween Janua y 2024 and June 2024.
S udy popula ion included 500 pa ien s. The absolu e Agas a on calcium sco es (ze o, mild, mode a e and se e e) o
age and gende we e abula ed and s a is ical analysis was done o ind mean age and p e alen gende o each ca ego y
o calcium sco e.
Resul s: Da a o 500 pa ien s was sc u inized. O hese, 183 pa ien s we e excluded due o e ascula iza ion (CABG o
s en s) o due o incomple e clinical in o ma ion. Ou o emaining 317pa ien s, 180 we e males and 137 we e emales.
•Ze o calcium sco e was ound in 146 pa ien s. Mean age was 47 yea s and M>F.
•Mild calcium sco e was ound in 76 pa ien s. Mean age was 53 yea s and M>F.
•Mode a e calcium sco e was ound in 62 pa ien s. Mean age was 55 yea s and M>F.
•Se e e calcium sco e was ound in 33 pa ien s. Mean age was 62 yea s and M>F.
Conclusion: In his s udy CAC sco es we e p o ided o men and women, wi h hei mean age; which is help ul in
he apeu ic decision-making. Non-ze o CAC sco e co esponded o mo e han hal o popula ion, wi h all ca ego ies
mo e p e alen in males. As an app oxima e ule o humb, he e is di ec ela ion in mean age wi h inc ease in he
se e i y ca ego y o calcium sco e.
Keywo ds: Co ona y a e y; Calcium sco e; Compu ed omog aphy; Agas a on
1. In oduc ion
App oxima ely hal o all ca dio ascula disease (CVD)– ela ed dea hs has no p io ca diac symp oms o diagnoses (1).
CT scan o co ona y a e y calcium (CAC) is an impo an ool in ca dio ascula isk assessmen and selec ion o
app op ia e p e en i e he apy in pa ien s wi h in e media e o unclea CVD isk (2, 3).
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1.1. Pa hophysiology o CAD
Co ona y a e y disease is ypically caused by a he oma ous na owing o he essel esul ing in blockage. A ma u e
plaque has wo componen s; mac ophages and smoo h muscle cells. The nec o ic " oam cells" - monocy e-de i ed
mac ophages ha in il a e in o he in ima and abso b lipids - a e he p ima y sou ce o he lipid co e. Smoo h muscle
cells mig a e in he ascula wall om he media in o he in ima, whe e hey mul iply o c ea e a ib ous capsule a ound
he lipid co e, o ming he connec i e issue ma ix .Calci ica ion o he co ona y a e ies occu s along wi h he
p og ession o se e e a he oscle osis. Co ona y a e y s enosis o mo e han 50% o a educ ion in diame e a ea by
80% usually leads o angina on exe ion. Occlusion is nea o al in acu e myoca dial in a c ion han uns able angina,
whe e a e ial occlusion is equen ly pa ial. Acu e co ona y e en s usually occu when a plaque up u es and ac i a es
he o ma ion o a h ombus (4).Fig 1.
Figu e 1 Pa hophysiology o co ona y a e y plaque o ma ion
2. Me hods
A e ospec i e s udy was conduc ed a Rawalpindi ins i u e o ca diology and da abase was sc eened o pa ien s who
unde wen CT ca diac angiog aphy and calcium sco e assessmen be ween Janua y 2024 and June 2024.
2.1. E hical app o al
The s udy was pe o med acco ding o he Decla a ion o Helsinki p inciples. In o med consen was wai ed o , as he
s udy was conduc ed e ospec i ely wi h he use o he hospi al da abase.
2.2. S udy popula ion
The au ho s o he s udy sc eened da a o 500 pa ien s who unde wen compu ed omog aphy co ona y angiog aphy
(CTCA) and CAC sco e calcula ion, be ween Janua y 01, 2024 and June 30, 2024, in he adiology depa men o
Rawalpindi Ins i u e o Ca diology, Pakis an.
The exclusion c i e ia we e
• Pa ien s wi h a co ona y s en o bypass g a
• Pa ien s wi h missing in o ma ion ega ding his o y o e ascula iza ion o calcium sco es.
O he 500 pa ien s, 183 we e excluded; inally, he s udy popula ion included 317 pa icipan s. Among he s udy
popula ion (n = 500), 287 had ecei ed bo h CAC sco ing and CTA, and 30 pa ien s had ecei ed CAC sco ing alone.
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2.3. Co ona y Compu ed Tomog aphy Angiog aphy and Co ona y A e y Calcium Sco e Calcula ion
Co ona y CTAs and CAC sco e calcula ions we e pe o med on a 640-de ec o CT scanne (Toshiba Aquillion One). A
be a-blocke was gi en o pa ien s wi h a hea a e o >65 bpm a leas one hou be o e co ona y CTA unde
ca diologis ’s supe ision. Scan was elec oca diog aphically igge ed a 60%–80% o he R-R in e al. Re ospec i e
ECG ga ing was pe o med in pa ien s wi h high hea a es o CTA, and p ospec i e ECG- igge ed CT acquisi ion was
used o CAC sco ing. Be o e injec ion o con as , non-enhanced images o CAC sco ing we e ob ained. In a enous
iodina ed con as was injec ed a a a e o 4–6 mL/sec, ollowed by saline in usion. S anda d pa ame e s o CTA and
CAC we e used. The CAC was desc ibed as a plaque o a leas h ee con iguous pixels wi h an a enua ion o ≥130
Houns ield uni s. The Vsco e (Toshiba Aquillion One) so wa e sys em was used o image pos -p ocessing, and he CAC
sco e was calcula ed using he Agas a on me hod.
Table 1 Classi ica ion o co ona y calcium absolu e con en e alua ed by ca diac CT and quan i ied by Agas a on uni s
Absolu e alue (agas a on uni s)
Ranking
0
Absen
>0<10
Minimal
>10<100
Mild
>100<400
Mode a e
>400<1000
Se e e
>1000
Ex ensi e
2.4. S a is ical analysis
The absolu e Agas a on calcium sco es (ze o, mild, mode a e and se e e--examples Fig 2-5) o age and gende we e
abula ed and s a is ical analysis was done o ind mean age and p e alen gende o each ca ego y o calcium sco e,
Table 1.
3. Resul s
Da a o 500 pa ien s was sc u inized. O hese, 183 pa ien s we e excluded due o e ascula iza ion (CABG o s en s) o
due o incomple e clinical in o ma ion. Ou o emaining 317pa ien s, 180 we e males and 137 we e emales. Figu es 6,
7.
• Ze o sco e was ound in 146 pa ien s. Mean age was 47yea s and M>F.
• Mild calcium sco e was ound in 76 pa ien s. Mean age was 53yea s and M>F.
• Mode a e calcium sco e was ound in 62 pa ien s. Mean age was 55yea s and M>F.
• Se e e calcium sco e was ound in 33 pa ien s. Mean age was 62yea s and M>F.
Figu e 2 Minimal Agas a on calcium sco e o 1
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Figu e 3 Mild Agas a on calcium sco e o 33
Figu e 4 Mode a e Agas a on calcium sco e o 178
Figu e 5 Se e e Agas a on calcium sco e o 2748
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Figu e 6 Mean age in each ca ego y o calcium sco e
Figu e 7 P e alen gende in each ca ego y o calcium sco e
4. Discussion
Con en ionally, CAC was conside ed as an es ima o o he p obabili y o obs uc i e co ona y a e y disease and migh
ha e esul ed di ec ly o ca diac ca he e iza ion. I is, howe e , mo e speci ic as a ma ke o o e all a he oscle o ic
plaque bu den (5).
One o he majo ad an ages o CAC is i s high nega i e p edic i e alue o clinically signi ican co ona y a e y disease
in middle-aged and olde indi iduals who had ela i ely inc eased isk es ima es om con en ional isk sco es bu we e
ound o be e y low isk by using CAC (6). I has also been use ul in he iden i ica ion o co e ca diac disease in
younge adul s, in whom CAC was inciden ally ound o be clinically signi ican , wa an ing p e en i e he apy (7).
Fu he mo e, i s bene i as a ool o physician-pa ien mu ual decision making is in aluable, as esea ch has shown ha
pa ien s who unde s and hei CAC sco e a e likely o be mo e complian o hei medica ions and li es yle
modi ica ions.
In 2018, he SCCT published he CAC Da a and Repo ing Sys em (CAC-DRS), a phenomenal app oach o epo ing CAC
ha aims o s anda dize he me hods o epo ing indings abou CAC on all ga ed ca diac scans and non-ga ed ches
CT scans.The CAC-DRS ca ego ies o 0–3 we e de ined o co ela e wi h he con en ional Agas a on sco e ca ego ies o
0 ( e y low isk), 1–99 (mild CAC, mildly inc eased isk), 100–299 (mode a e CAC, mode a ely inc eased isk), and
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highe han 300 (mode a ely o se e ely inc eased isk).Visual assessmen o CAC on non-ga ed scans is done wi h hese
same ca ego ies in mind, wi h sco es o 0–3 co esponding o simila isk ca ego ies (8),Table 2.
Table 2 CAC Da a and epo ing sys em wi h ea men ecommenda ion
Cac da a and epo ing sys em (cac d s)
Cac-d s
Agas on
Visual
Risk
T ea men ecommenda ion
0
0
0
Ve y low
S a in no ecommended
1
1-99
1
Mildly inc eased
Mode a e in ensi y s a in
2
100-199
2
Mode a ely inc eased
Mode a e o high in ensi y s a in+81mg
aspi in
3
>300
3
Mode a ely o se e ely
inc eased
High in ensi y s a in+81mg aspi in
5. Conclusion
The co ona y a e ies calcium sco e is a eliable p edic o o CAD e en s. I is being widely accep ed because o i s non-
in asi eness and high accu acy in p edic ing a he oscle o ic CAD isk in indi iduals wi h low o mode a e clinical isk.
By publishing his a icle, we hope ha clinicians will be able o use CAC sco ing as a alid sc eening ool o ea ly
diagnosis o CAD in pa ien s, allowing hem o ake he app op ia e p e en a i e ac ions, o dec ease CAD- ela ed
mo ali y and mo bidi y. Addi ionally, ecen de elopmen s in he applica ion o a i icial in elligence show b igh
p ospec s; wi h he de elopmen o CAC CT pos -p ocessing algo i hms and so wa e o au oma e he es ima ion and
epo ing o CAC.
Compliance wi h e hical s anda ds
Acknowledgemen s
The au ho s would like o hank depa men s o Radiology and Ca diology, especially he echnicians and medical
ansc ip ionis s who assis ed in e e y s ep o his esea ch wo k.
Disclosu e o con lic o in e es
The au ho s ha e no con lic s o in e es o be disclosed.
Au ho Con ibu ions
All au ho s ha e e iewed he inal e sion o be published and ag eed o be accoun able o all aspec s o he wo k.
Re e ences
[1] G eenland P, Alpe JS, Belle GA, e al. 2010 ACCF/AHA guideline o assessmen o ca dio ascula isk in
asymp oma ic adul s: a epo o he Ame ican College o Ca diology Founda ion/Ame ican Hea Associa ion
Task Fo ce on P ac ice Guidelines. J Am Coll Ca diol 2010; 56(25):e50–e103. [DOI] [PubMed] [Google Schola ]
[2] G eenland P, Bonow RO, B undage BH, e al. ACCF/AHA 2007 clinical expe consensus documen on co ona y
a e y calcium sco ing by compu ed omog aphy in global ca dio ascula isk assessmen and in e alua ion o
pa ien s wi h ches pain: a epo o he Ame ican College o Ca diology Founda ion Clinical Expe Consensus
Task Fo ce (ACCF/AHA W i ing Commi ee o Upda e he 2000 Expe Consensus Documen on Elec on Beam
Compu ed Tomog aphy) de eloped in collabo a ion wi h he Socie y o A he oscle osis Imaging and P e en ion
and he Socie y o Ca dio ascula Compu ed Tomog aphy. J Am Coll Ca diol 2007;49(3):378–402. [DOI]
[PubMed] [Google Schola ]
[3] G eenland P, Blaha MJ, Budo MJ, E bel R, Wa son KE. Co ona y Calcium Sco e and Ca dio ascula Risk. J Am Coll
Ca diol 2018;72(4):434–447. [DOI] [PMC ee a icle] [PubMed] [Google Schola ]
Wo ld Jou nal o Biology Pha macy and Heal h Sciences, 2025, 21(01), 343-349
349
[4] Pa hophysiology and in es iga ion o co ona y a e y disease. G ech ED. BMJ. 2003;326:1027–1030. doi:
10.1136/bmj.326.7397.1027. [DOI] [PMC ee a icle] [PubMed] [Google Schola ]
[5] Blaha MJ, Mo ensen MB, Kianoush S, To a-Maha aj R, Cainzos-Achi ica M. Co ona y A e y Calcium Sco ing: Is I
Time o a Change in Me hodology? JACC Ca dio asc Imaging 2017;10(8):923–937. [DOI] [PubMed] [Google
Schola ]
[6] Blaha M, Budo MJ, Shaw LJ, e al. Absence o co ona y a e y calci ica ion and all-cause mo ali y. JACC
Ca dio asc Imaging 2009;2(6):692–700. [DOI] [PubMed] [Google Schola ]
[7] Miedema MD, Da da i ZA, Nasi K, e al. Associa ion o Co ona y A e y Calcium Wi h Long- e m, Cause-Speci ic
Mo ali y Among Young Adul s. JAMA Ne w Open 2019;2(7):e197440. [DOI] [PMC ee a icle] [PubMed] [Google
Schola ]
[8] Hech HS, Blaha MJ, Kaze ooni EA, e al. CAC-DRS: Co ona y A e y Calcium Da a and Repo ing Sys em. An expe
consensus documen o he Socie y o Ca dio ascula Compu ed Tomog aphy (SCCT). J Ca dio asc Compu
Tomog 2018;12(3):185–191. [DOI] [PubMed] [Google Schola ]
Au ho sho biog aphy
Au ho is a lead adiologis wo king in a e ia y ca e ca diac cen e in Rawalpindi, Pakis an. I ’s
a 300 bedded hospi al wi h 24/7 ER se ices, pedia ic and adul ca diology and ca diac su ge y
se ices; bigges public sec o ca diac cen e in he egion. This cen e has a well-equipped
imaging depa men wi h i s own 3-Tesla MRI, and 640 slice CT scanne s, la es Doppe , echo
and x- ay machines. She is ully in ol ed in epo ing ca diac CTs and MRIs along wi h eaching
and aining o pos -g adua e ainees, also ul illing adminis a i e esponsibili ies o
depa men e icien ly. She has a ended many Na ional and In e na ional con e ences and ha e
nume ous publica ions in na ional and in e na ional jou nals.
