Arq. Bras. Cardiol. 2018; 110(5): 428-429
Not Everything that Shines is Calcium
DOI: 10.5935/abc.20180084
This Short Editorial is referred by the Research article "Atherosclerotic Plaque in Patients with Zero Calcium Score at Coronary Computed Tomography Angiography".
Coronary calcification is involved in the pathophysiological process of atherosclerosis, particularly at later stages of the disease, as part of its healing process. In fact, calcification is not required for plaque development or progression, or luminal obstruction, or even for the development of cardiovascular events – these processes, in addition to plaque instability is commonly seen. Our group showed, in a randomized clinical trial on symptomatic patients, that 20% of vessels with complete obstructions in invasive angiography had no calcification according to calcium scoree, corroborating histopathological studies that demonstrated the absence of calcification in a considerable number of the coronary plaques evaluated. Understanding or the pathophysiology of coronary disease is essential to contextualize calcium score in population studies.
These studies, however, have shown some controversial results on the rates of cardiovascular events and obstructive lesions. The reason for this apparent divergence of results is the study population. Asymptomatic patients with zero calcium score are different from symptomatic ones without calcification, who in turn, are different from patients with history of early coronary disease, diabetics or smokers with zero calcium score.
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