Coronary artery calcium in the population-based ImaLife study:relation to cardiovascular risk factors and cognitive function

Cardiovascular disease is the leading cause of death worldwide. Coronary artery disease (CAD) is the most common type of cardiovascular disease and its primary prevention is promising to reduce health and economic burden. Risk assessment is the core of primary prevention of CAD. The coronary artery calcium (CAC) score, a surrogate for coronary atherosclerosis, is a promising imaging biomarker that can improve cardiovascular risk prediction. Perquisitions of wide implementation of CAC scoring for cardiovascular risk management include standardized quantification methods and validated reference values. In this thesis, the study design and rationale of the ImaLife study is described, and CAC score distribution is investigated in relation to cardiovascular risk factors and cognitive function in a general Dutch population. The research is performed in the framework of the ImaLife study, which is embedded in the Lifelines cohort in the northern part of the Netherlands. Results show that cardiovascular risk can be reliably assessed based on CAC scoring on non-ECG-triggered chest CT with a third-generation, dual-source CT scanner in high-pitch mode. The CAC score may substantially impact CAD risk assessment. Besides, the CAC score per se can be a surrogate outcome of clinical CAD and, therefore, can be helpful in identifying new risk factors for CAD. In addition, the CAC score seems to be promising in predicting the risk of cognitive impairment and dementia. Future prospective longitudinal studies should evaluate the predictive value of CAC score for CAD and dementia, as well as the relationship between new risk factors and CAC