The role of coronary CT angiography and personal life-style habits in risk assessment for primary protection from cardiovascular diseases

Aim: Atherosclerotic cardiovascular diseases (CVD) are the most common cause of mortality and morbidity in the world. Cardiovascular disease risk factors are; As there are factors that cannot be modified such as age, gender, family history of CVD; There are also risk factors that can be modified such as hyperlipidemia (HL), hypertension (HT), smoking, diabetes mellitus (DM), alcohol, obesity, physical inactivity, unhealthy diet (1). In addition, recent studies have shown that the individual's socioeconomic level, educational status, social environment support, cognitive and mood functions, and systemic inflammation also pose a risk for CVD and have taken place in the guidelines (2) (3) (4) (5). In the light of the studies, it is known that the Agatston score, which measures coronary artery calcium (CAC) in cardiac CT, is an independent predictor of coronary artery disease (CAD) (6) (7).While the Systematic Coronary Risk Evaluation (SCORE) risk model, which is widely used to calculate CVD risk, includes classical atherosclerotic risk factors, it is seen that there are many new risk factors that affect the results of this system. Therefore, there is a need to add new parameters that will increase the power of risk assessment in addition to new updated scoring systems or SCORE system. The aim of this study is; To investigate the importance of coronary computed tomographic (CT) angiography findings and sociocultural and lifestyle characteristics of patients in primary cardiovascular prevention in patients admitted to cardiology outpatient. Method: 565 patients who applied to the Izmir Medical Park Hospital cardiology outpatient clinic between 15.01.2019-20.01.2020 and underwent CBTA for any reason were screened. Patients with known CAD were excluded, 497 people were included in the study and the questionnaire was applied. From the questionnaire, the age, height, weight, gender, cardiovascular risk factors, presence of chest pain, socioeconomic, cultural and lifestyle characteristics of the person were learned. Laboratory findings were obtained from the hospital information recording system. Predicted cardiovascular mortality for 10 years was calculated in accordance with the SCORE risk scale. Coronary atherosclerosis and cardiac morphology were evaluated by examining the CBTA results on the radiology archive. Agatston coronary artery calcium score (CACS), hepatosteatosis, paracardial adipose tissue (PAT) thickness, epicardial adipose tissue (PAT) thickness, and sub-skin adipose tissue (AT) thickness were measured. Data of individuals were analyzed in terms of presence of atherosclerosis and Agatston calcium scores detected in coronary Bt angiography. Parameters that were significant in univariate analysis were included in multivariate analysis, and independent predictors of atherosclerosis and agate scores were investigated. Result: Demographic, laboratory, lifestyle data and cardiac CT of 497 patients who underwent cardiac CT for any reason were evaluated. The average age was 54 ± 13 and 63% were male. Agatston CKS was categorized using threshold values of 0 and 100, and then, in the first analysis, patients were divided into patients with an Agatston CCS of zero and those with greater than zero and compared. Age, male gender, body mass index (BMI), SCORE, HT, DM, cerebrovascular event (CVA), creatinine level, active working life, presence of atherosclerosis, significant coronary artery stenosis, EAT / PYD thickness were statistically significant. As a result of multivariate analysis, SCORE significantly predicted PYD thickness and active working life Agatston KKS = 0. Thereupon, the threshold value for PYD was found to be 5 mm by Roc analysis (p = 0.000 Area under the curve: 0.597, 95% CI: 0.547-0.648). According to the results of this analysis; Agatston KKS = 0; SCORE <5 was 9.1 times (p = 0.000 OR: 9.128, 95% CI: 3.341-29.943), PYD thickness <5 mm was 2.6 times (p = 0.018 OR: 2.677, 95% CI: 1.185- 6,048) predicted. When the patients were grouped according to the Agatston threshold value of 100, it was found that the parameters similar to Agatston = 0 group were significant as a result of the analysis. Looking at the relationship between SCORE risk and KKS; It was observed that 7 of 100 patients with low-medium SCORE risk had Agatston score above 100, and CRS = 0 in 56 of 85 patients with medium SCORE risk. The patients were grouped according to the presence / absence of atherosclerosis and their relationship with the cardiometabolic risk factors DM, BMI, inflammatory disease, hepatosteatosis, PYD, EAT, LDL-C, HDL-C, TG, TC, neutrophil / lymphocyte were evaluated. DM, EYD, PYD, and neutrophil / lymphocyte ratio were statistically significant. In multivariate analysis; PYD thickness (p = 0.000, OR: 1.1412, 95% CI: 1.061-1.229) and neutrophil / lymphocyte ratio (p = 0.033, OR: 1.386, 95% CI: 1.026-1.872) were found to be independent predictors of the presence of atherosclerosis. Conclusion: With this study, data on the atherosclerosis profile of the Turkish population were obtained. Cardiac CT has entered the routine of our lives in cardiology with many indications in the guidelines. It is now seen that it is preferred in the asymptomatic patient due to the presence of risk factors. As a result of this study, the paracardial adipose tissue thickness measured in cardiac CT; It has been concluded that the SCORE system can be useful as a parameter to predict an individual's atherosclerosis. We can add hepatosteatosis measurement practically to our routine with epicardial / paracardial adipose tissue measurement, which can be easily measured in cardiac CT performed at normal standards, and we can make the primary prevention of people more effective. Also, we saw that Agatston CACS, which we examined with coronary CT, changed the cardiovascular risk category of people; This practice will prevent the use of unnecessary drugs when it reduces the risk, and will direct people to receive effective medical treatment in cases where the risk increases. Our study is a single center cross-sectional study and more prospective studies are needed to illuminate these issues. Key Words: Coronary CT angiography (CBTA), coronary artery calcium score (CACS), SCORE risk model, Primary prevention from cardiovascular diseases, Paracardial adipose tissue (PAT)