Correlation between Coronary Artery Calcium- and Different Cardiovascular Risk Score-Based Methods for the Estimation of Vascular Age in Caucasian Patients

Vascular age can be derived from cardiovascular (CV) risk scores such as the Framingham Risk Score (FRS) and the Systematic Coronary Risk Evaluation (SCORE). Recently, coronary artery calcium score (CACS) was proposed as a means of assessing arterial age. We aimed to compare these approaches for the assessment of vascular age. FRS-, SCORE-, and CACS-based vascular ages of 241 consecutive Caucasian patients undergoing coronary CT angiography were defined according to previously published methods. Vascular ages based on FRS, SCORE, and CACS were 68.0 (IQR: 55.0–82.0), 63.0 (IQR: 53.0–75.0), and 47.1 (IQR: 39.1–72.3) years, respectively, (p < 0.001). FRS- and SCORE-based biological age showed strong correlation [ICC: 0.91 (95%CI: 0.88–0.93)], while CACS-based vascular age moderately correlated with FRS- and SCORE-based vascular age [ICC: 0.66 (95%CI: 0.56–0.73) and ICC: 0.65 (95%CI: 0.56–0.73), respectively, both p < 0.001)]. Based on FRS, SCORE, and CACS, 83.4%, 93.8%, and 42.3% of the subjects had higher vascular age than their documented chronological age (FRS+, SCORE+, CACS+), and 53.2% of the FRS+ (107/201) and 57.1% of the SCORE+ (129/226) groups were classified as CACS-. Traditional risk equations demonstrate a tendency of overestimating vascular age in low- to intermediate-risk patients compared to CACS. Prospective studies are warranted to further evaluate the contribution of different vascular age calculations to CV preventive strategies.