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As foam-cell and lipid-pool accumulates over time, the arterial intimal layer thickens and atheromatous plaques eventually develops, which can potentially lead to tissue ischaemia.1 The progression of atherogenesis can affect the circulation of the heart or the brain, with myocardial infarction and ischaemic stroke among the debilitating consequences. In advanced atherosclerosis, the presence of calcified deposits is an important feature in these atheromatous plaques and it is informative of subsequent risk of atherosclerotic cardiovascular disease (ASCVD). Various modalities have been used to detect vascular calcification, and the coronary artery calcium (CAC) is a widely used indicator of atherosclerotic burden, thereby, a predictor of future risk of ASCVD.2 Although debate exists regarding the use of CAC as a screening tool to assess and manage ASCVD risk,3 several clinical guidelines have suggested the utility of CAC score to improve risk stratification and guide clinical management, particularly for those who are at low or intermediate risk of ASCVD.4 5 Nevertheless, the cost of assessing CAC is not negligible, and exposure to radiation when assessing CAC using CT scan might be an issue for some.
Interestingly, calcification of the arterial tissue has long been recognised …
Contributors DC wrote the first draft and KR contributed in the revision of the draft.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests DC and KR have received support from the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, British Heart Foundation and the Oxford Martin School. The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR or the Department of Health and Social Care.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.
Provenance and peer review Commissioned; internally peer reviewed.
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