ABSTRACT
Coronary calcium is an indicator of the presence of coronary atherosclerosis.6,7
The only exception is Mönckeberg’s calcific medial sclerosis, which is associated with calcium deposition in the media and occurs particularly among patients with diabetes mellitus.The amount of coronary calcium is directly related to the extent of the underlying atherosclerotic plaque burden. However, the amount of calcium underestimates the total atherosclerotic plaque burden and the amount of coronary calcium detected is about one-fifth of the measured total atherosclerotic plaque burden.6,7
Higher amounts of calcium are associated with a higher likelihood of adverse coronary events, but the direct relation of higher calcium scores with increased likelihood of adverse events should be regarded as a reflection of the higher extent of underlying coronary atherosclerosis rather than the instability of a calcified plaque.8-11 The absence of calcium does not exclude the presence of coronary atherosclerosis but is associated with a low likelihood of advanced coronary atherosclerosis and very low likelihood of an adverse coronary event.8-11 Thus calcium is neither a marker for plaque vulnerability nor for plaque stability. The prevalence and amount of coronary calcium increases with age in both men and women, although in women there appears to be a lag time of 10 years compared to men. Men generally have higher calcium scores than women (Table 13.1).12
