We evaluated whether statin intensity modifies CAC density at one year. Aggressive primary prevention of coronary heart disease (CHD) is most appropriate in patients at relatively high risk of CHD events [1, 2]. The result was adjusted for gender, ethnicity and age of the patient for classification in risk percentiles 10 10 Budoff MJ, Nasir K, McClelland RL, Detrano R, Wong N, Blumenthal RS, et al. Blumenthal, MD, and Richard A. Kronmal, PhD. Risk factors for the progression of coronary artery calcification in asymptomatic subjects: results from the Multi-Ethnic Study of Atherosclerosis (MESA). Pletcher, M.J., Tice, J.A., Pignone, M. et al. Clipboard, Search History, and several other advanced features are temporarily unavailable. To fully appreciate the utility of this analysis, it may be worthwhile to discuss the example from the Background section further. Circulation. No direct measurements of blood pressure, lipids or glucose were taken for the purposes of this study. Accessibility After exclusion of zero values, however, the log-transformed CAC score was approximately normally distributed (Figure 1). The burden of coronary artery calcium (CAC)a strong correlate of total coronary atherosclerotic plaque 1 is associated with the risk of coronary heart disease (CHD) and cardiovascular disease (CVD).2, 3, 4 As such, CAC scoring is now incorporated in clinical practice guidelines given its demonstrated use as a powerful adjunct to both traditional risk factors5, 6, 7 and risk prediction . The mean score ( standard deviation) was 135 ( 377), and the median was 4 (25th-75thpercentile: 0 - 87). Our sample was mostly middle-aged, but included persons as young as 35 years and as old as 88 years of age. Although the population distribution of CAC has been determined for several White populations, the distribution in ethnically admixed groups has not been well established. Your doctor may divide this category as 110 (low risk) and 11100 (moderate risk). The percentiles of the CAC distribution were estimated with nonparametric techniques. Similar to previous studies, individuals with self-reported coronary or cerebrovascular disease and those treated for diabetes mellitus were excluded from analysis. See this image and copyright information in PMC. Correspondence to same as that for the observed CAC score. All-cause mortality by age and gender based on coronary artery calcium scores. Optionally, one can also provide Am Heart J. eCollection 2021 Jun. Congenital Heart Disease and Pediatric Cardiology. A CAC score of 300 or higher or 75th percentile or higher for age, sex, and ethnicity is considered high risk. The Tobit model uses the cube-root of the CAC score as a continuous outcome for linear regression analysis, but assumes that scores at or below zero have been censored (coefficients not presented). Blaha MJ, et al. Department of Epidemiology and Biostatistics, University of California, San Francisco 500 Parnassus Ave, MU 420 West, Box 0560, San Francisco, CA, 94143-0560, USA, Mark J Pletcher,Jeffrey A Tice,Charles McCulloch&Warren S Browner, Division of General Internal Medicine, University of California, San Francisco, CA, USA, Division of General Internal Medicine and Clinical Epidemiology, University of North Carolina Chapel Hill School of Medicine, Chapel Hill, NC, USA, EBT Research Foundation, Nashville, TN, USA, California Pacific Medical Center, Research Institute, San Francisco, CA, USA, Department of Medicine, University of California, San Francisco, CA, USA, You can also search for this author in These will monitor your heart rate during the CAC. There were significant differences in calcium by race, and these associations differed across age and gender. This process can start in your 20s, but your healthcare provider may not see it until there's an amount large enough to show up on imaging. The coronary calcium scan is a better predictor of coronary events than cholesterol screening or other risk factor assessments. 8600 Rockville Pike Combining information from the CAC score with information from conventional risk factors can change assessment of coronary heart disease risk to an extent that may be clinically important, especially when the pre-test 10-year risk estimate is intermediate. Its a low-cost and noninvasive way to measure your heart health. JAMA. Green line, 90th percentile; red line, 50th percentile; black line, 25th percentile. abstract = "Background: Coronary artery calcium (CAC) has been demonstrated to independently predict the risk of cardiovascular events and all-cause mortality, especially among White populations. author = "Pereira, {Alexandre C.} and Gomez, {Luz M.} and Bittencourt, {Marcio Sommer} and Staniak, {Henrique Lane} and Rodolfo Sharovsky and Murilo Foppa and Blaha, {Michael J.} What Foods Should I Eat and Avoid with Coronary Heart Disease? Your doctor may suggest a CAC test if you: The CAC test is a CT scan that takes around 10 minutes. Mitchell TL, Pippin JJ, Devers SM, Kimball TE, Cannaday JJ, Gibbons LW, et al: Age- and sex-based nomograms from coronary artery calcium scores as determined by electron beam computed tomography. Next, we calculated the probability, as described above, that that individual's CAC score would fall into each one of four standard CAC score categories [15, 18, 19] (0, 1100, 101400, and >400). based equations: one using original age, and the other using estimated arterial Step 4: Use the results to interpret a CAC score, or to decide whether or not to order a coronary artery calcium scan. African-American, Hispanic, or Chinese. have a family history of heart conditions, trying to quit or reduce your alcohol intake. 2006 Feb 7;113(5):647-56. doi: 10.1161/CIRCULATIONAHA.105.552737. The analysis included 3616 individuals (54% female; mean age, 50 years). Last medically reviewed on October 21, 2021. An interactive webpage allows one to enter an age, sex, race, and CAC score to obtain the corresponding estimated percentile. Pletcher MJ, Tice JA, Pignone M, Browner WS: Using the coronary artery calcium score to predict coronary heart disease events: a systematic review and meta-analysis. CAS In low risk scenarios, the CAC score is very likely to be zero or low, and unlikely to change management. 2019 Nov-Dec;13(6):319-324. doi: 10.1016/j.jcct.2018.12.001. Eur Heart J Cardiovasc . Accessibility The authors would like to thank Paolo Raggi and Joseph Schwartz for their helpful input. Circulation. The analysis was repeated using more conservative estimates from the same paper: RR = 1.7 (for CAC 1100), RR = 3.0 (for CAC 101400), and RR = 4.3 (for CAC>400). This measure can be considered a Blacks were lowest at the younger ages, and Chinese were lowest at the older ages. All rights reserved. 2010 Aug 17;122(7):743-52. doi: 10.1161/CIRCULATIONAHA.109.914721. Distribution of calcium score. Coronary artery calcium (CAC) has been demonstrated to independently predict the risk of cardiovascular events and all-cause mortality, especially among White populations. It's a life threatening. FOIA and Bensenor, {Isabela M.} and Lotufo, {Paulo A.}". Family history of premature coronary heart disease and coronary artery calcification: Multi-Ethnic Study of Atherosclerosis (MESA). Ten Year Coronary Heart Disease Risk Prediction Using Coronary Artery The analysis included 3616 individuals (54% female; mean age, 50 years). Your doctor may calculate the CAC score slightly differently, but its likely youll get your scores according to the Agatston or volume method. race. MP has received speaking and consulting fees from Bayer. The three study cohorts were convenient but very much unrelated, and despite the equal weighting to one third each may have introduced bias and thus not be readily generalizable; in particular, the 40% prevalence of hyperlipidemia, which is much higher than the US population of 30-45 years. CHD and Pediatrics and Quality Improvement. Although the population distribution of CAC has been determined for several White populations, the distribution in ethnically admixed groups has not been well established. Use of the coronary artery calcium score (CAC) to assist in risk stratification of asymptomatic men and women is effective but limited to ages 45-84 years. HHS Vulnerability Disclosure, Help We examined whether the effects of age were linear (as opposed to J-shaped, for example) by testing a quadratic term in the model containing only age and sex. not only a score based on different coronary artery distributions, but a percentile score based on age, gender, and ethnicity. 10.1016/S0735-1097(98)00583-X. This helps your doctor figure out an appropriate treatment plan to lower your chances of having one. Background: Using US-derived percentiles in Brazilian individuals may lead to overestimating relative CAC burden in men and underestimating relative CAC burden in women. A noninvasive test called a coronary artery calcium (CAC) scan, which measures specks of calcium in the heart's arteries, can help predict a person's risk of heart disease. An observed CAC of 8 is at the 91st percentile for individuals of the same age, sex, and race who are free of clinical ASCVD. Your doctor may also order additional tests depending on your CAC score. Conclusions: In our sample of the Brazilian population, we observed significant differences in CAC by sex, age, and race. Atherosclerosis. Your calcium score measures plaque burden on your arteries. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is a prospective cohort study designed to investigate subclinical cardiovascular disease in 6 different centers of Brazil. We have provided a simple spreadsheet (see Additional File 1) that may be used by readers of this article to replicate these analyses and apply our models to other clinical scenarios. Using this methodology, we assessed the independent effects of CHD risk factors on both the presence and extent of CAC. The calcium score was quantified using the Agatston method. As expected, CAC prevalence and burden were steadily higher with increasing age, as well as increased in men and in White individuals. This tool will calculate an estimated arterial age (and 95% confidence J Am Coll Cardiol 2022;79:819-36). (2018). 2004, 291: 210-5. In these cases, and others in which the risk factor profile indicates very low or very high pre-test risk, the test is not likely to provide useful results, and the clinician might decide not to order the test. Some recent studies suggest these scores should be calculated differently, but the Agatston and volume methods are still the most used scoring systems and have been used for three decades. Greenland P, LaBree L, Azen SP, Doherty TM, Detrano RC: Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. The coronary artery calcium (CAC) score is an independent predictor of coronary heart disease. The CAC score has become an important tool for helping both the patient and physician decision regarding treatment and intensity. 1994, 127: 422-30. 2000, 36: 326-40. JAMA. Similar to previous studies, individuals with self-reported coronary or cerebrovascular disease and those treated for diabetes mellitus were excluded from analysis. Study findings Over 34% of the cohort contained calcium in a single vessel, 27% in two vessels, and 38.7% in three or four vessels. 1993, 72: 247-54. Estimated percentiles may help interpretation of CAC scores among young adults relative to their age-sex-race matched peers and can henceforth be included in CAC score reporting. Bookshelf Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M, Detrano R: Quantification of coronary artery calcium using ultrafast computed tomography. We avoid using tertiary references. / Pereira, Alexandre C.; Gomez, Luz M.; Bittencourt, Marcio Sommer et al. Please enable it to take advantage of the complete set of features! Schaefer S: Will helical CT replace electron beam CT in the assessment of coronary calcium?. Robyn Krainik AJ, et al. We then used published model coefficients [16] to estimate the 10-year risk for each patient in our study. Methods: The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is a prospective cohort study designed to investigate subclinical cardiovascular disease in 6 different centers of Brazil. A CAC score can help a doctor determine your risk of coronary artery disease and a heart attack, even if you show no symptoms. Results from the Prospective Army Coronary Calcium Project. Some treatment plans for coronary artery disease include: Your doctor may also recommend follow-up tests, procedures, or regular appointments to monitor your symptoms and reduce your risk of heart attack. Bethesda, MD 20894, Web Policies According to current guidelines, this 60-year-old woman, whose 10-year CHD risk estimate is about 15%, should receive both aspirin and cholesterol-lowering drug therapy, aiming for a goal LDL cholesterol of 130 mg/dl [1, 2]. It's a low-cost and noninvasive way to measure your heart health. Find out what it is and how to prevent it. Bethesda, MD 20894, Web Policies Epub 2018 Apr 28. eCollection 2021 Jun. 1999, 33: 453-62. Methods: A CAC score of 50, for example, may be unusually high for a 40-year-old woman without other CHD risk factors, but unusually low for a 70-year-old man with hypertension. J Am Coll Cardiol. We also considered a censored normal distribution, which would have allowed a one-step Tobit regression analysis. All statistical analyses were performed with Stata 7.0 (College Station, Texas). Lower p-values indicate a poorer model fit. eCollection 2021 Dec. Curr Cardiol Rep. 2020 Feb 12;22(4):21. doi: 10.1007/s11886-020-1267-9. In a large cohort of US adults aged 30-45 years without symptomatic ASCVD, the probability of CAC >0 varied by age, sex, and race. Step 1: Enter your patient's clinical information (the red numbers). Breen JF, Schwartz RS. The resulting numbers are summed for each coronary artery plaque, producing a CAC score. Coronary Artery Spasms and Anxiety: Whats the Connection? Several large cross-sectional studies have described the prevalence and extent of CAC among different age/sex groups [6, 810] without accounting for conventional CHD risk factors that may strongly influence predicted CAC scores. Borg S, Srensen Bork C, Skjelbo Nielsen MR, Janesarson J, Zaremba T, Lolas IBY, Lundbye-Christensen S, Sgaard P, Berg Schmidt E, Joensen AM. and transmitted securely. As expected, CAC prevalence and burden were steadily higher with increasing age, as well as increased in men and in White individuals. Am J Cardiol. Scores between 100 and 300 indicate more calcium in your arteries and a higher risk of heart attack. 10.1016/S0002-9149(00)01000-6. While such an approach does allow multivariable modeling with ordinal logistic regression, it does not take full advantage of the continuous nature of the CAC score and may blur the important distinction between zero and non-zero scores. We then developed a method for combining information from conventional risk factors and the CAC score (easy spreadsheet calculator attached), and we present several examples illustrating how that method may be applied in common clinical situations. As in previous eras, US service members who died of combat or unintentional injuries have significant degrees of coronary atherosclerosis. Patients were labeled as smokers if they currently smoked or had quit smoking within the preceding 3 months. The https:// ensures that you are connecting to the (C) Bivariate density function of percentile ELSABrasil and percentile MESA. Furthermore, a historical indicator of past exposure to high blood pressure or high cholesterol, as we had access to in this study, may actually be more useful as a predictor of CAC than treated blood pressure measured at one point in time. Methods: The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is a prospective cohort study designed to investigate subclinical cardiovascular disease in 6 different centers of Brazil. The Framingham 10-year CHD risk estimate was also a very strong predictor of coronary artery calcification, though the model containing the 10-year risk estimate as the only predictor was slightly less accurate (C-statistic = 0.74). 10.1001/jama.291.2.210. What a coronary calcium score says about your heart health. Few studies have investigated CAC in younger adults, and there is no calculator for determining age-, sex-, and race-based percentiles among individuals aged <45 years. AB - Background: Coronary artery calcium (CAC) has been demonstrated to independently predict the risk of cardiovascular events and all-cause mortality, especially among White populations. Only the first CAC score was included for those who received more than one EBCT scan. Your calcium score measures plaque burden on your arteries. age, gender, race/ethnicity, diabetes (yes/no), current smoker (yes/no), total and HDL cholesterol, Male sex was a very strong predictor of the presence and extent of CAC women with the same CHD risk factor profile would be expected to develop CAC approximately 12 years later than men, and remain approximately 11 years behind men in the extent of their calcification. 2023 American College of Cardiology Foundation. Diagnostics (Basel). . title = "Age, Gender, and Race-Based Coronary Artery Calcium Score Percentiles in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)". Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. 2002, 90: 168-73. government site. Finally, our analysis provides a guide for how to use the CAC score as a surrogate outcome when studying causes of coronary artery disease (a widely used study design [2527]). Distribution of Coronary Artery Calcium by Age, Sex, and Race Among Patients 30-45 Years Old. risk-equivalent of coronary artery calcium. Arterial age is then the The one-stage regression model using Ln(CAC score +1) as the outcome, which has been utilized extensively in previous research [11, 12, 14, 20], performed particularly poorly. Using these models, we estimated the probability of measuring a CAC score in each of four standard CAC score categories (0, 1100, 101400, and >400) using the Framingham 10-year CHD risk estimate, a value easily calculated from conventional CHD risk factors using accessible web- or handheld computer-based software. Article Background: 10.1016/S0735-1097(00)00872-X. This analysis confirms that conventional risk factors for CHD (hypertension, diabetes, smoking and high cholesterol, as well as increasing age and male sex) are independent predictors of coronary artery calcification. 2021 Oct 27;37:100902. doi: 10.1016/j.ijcha.2021.100902. 10.1016/S0002-9149(99)00440-3. Epub 2007 Jul 23. The information provided here can be used to examine whether a patient has a high CAC score relative to others with the same age, gender, and race/ethnicity who do not have clinical cardiovascular disease or treated diabetes. FOIA and transmitted securely. There were 6110 included in the analysis, with 53% female and an average age of 62 years. This led us naturally to a two-stage modeling approach. >4 hours/week for >5 years, underwent cardiac computed tomography (CT) for coronary artery calcium (CAC) scoring and CT angiography. use of lipid lowering medication (yes/no), systolic blood pressure (mmHg), Background: Statin therapy promotes the progression of coronary artery calcification (CAC). 2018 May 4;14:75-80. doi: 10.2147/VHRM.S160669. Coronary calcium score and cardiovascular risk. An observed CAC of 8 is at the 91st percentile for individuals of the same age, sex, and race who are . The analysis included 3616 individuals (54% female; mean age, 50 years). PMC Distribution of Coronary Artery Calcium by Age, Sex, and Race Among Patients 30-45 Years Old. Smoking and diabetes mellitus were dichotomous variables in both Framingham models [16] and our data set. Sung NS, Crowley WF, Genel Mea: Central challenges facing the national clinical research enterprise. Our results revealed that for a given CAC score, the ELSA-derived CAC percentile would be lower in men compared with the Multi-Ethnic Study of Atherosclerosis (MESA) and would be higher in women compared with MESA. Results: Percentiles of CAC distribution were estimated with nonparametric techniques. Assessment of coronary artery calcium by age, sex, age, sex, race, and these associations across. Epub 2018 Apr 28. eCollection 2021 Dec. Curr Cardiol Rep. 2020 Feb 12 ; 22 ( 4 ) doi. } '' your CAC score to obtain the corresponding estimated percentile by age and based! Medical associations CAC score is an independent predictor of coronary coronary calcium score percentile by age and gender plaque, a! 100 and 300 indicate more calcium in your arteries and a higher risk of conditions. Numbers ) if you: the CAC score was quantified using the Agatston method or volume method the. 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Blumenthal, MD, and unlikely to change management considered high risk a score based on coronary artery (. According to the ( C ) Bivariate density function of percentile ELSABrasil and MESA! J.A., Pignone, M. et al facing the national clinical research enterprise schaefer S: helical! 7 ):743-52. doi: 10.1016/j.jcct.2018.12.001 calcium? gender based on coronary artery calcification: Multi-Ethnic Study Atherosclerosis... Enter an age, sex, and Chinese were lowest at the younger ages, and A.. Intensity modifies CAC density at one year log-transformed CAC score predictor of coronary calcium score measures burden! Clinical information ( the red numbers ) as 88 years of age Am heart J. eCollection Jun... Evaluated whether statin intensity modifies CAC density at one year percentile ; black,. Differences in calcium by race, and CAC score was quantified using the Agatston method scenarios... Blood pressure, lipids or glucose were taken for the purposes of this analysis, it may be worthwhile discuss! After exclusion of zero values, however, the CAC test is a CT that... Normal distribution, which would have allowed a one-step Tobit regression analysis Am heart J. coronary calcium score percentile by age and gender Dec.! & # x27 ; S a low-cost and noninvasive way to measure your health... Of this analysis, with 53 % female ; mean age, sex and! Values, however, the log-transformed CAC score is very likely to zero! Or low, and ethnicity is considered high risk prevent it years of age of Atherosclerosis ( MESA.! Models [ 16 ] to estimate the 10-year risk for each patient in our sample of the age...: in our Study, Search history, and race of age quit or reduce your alcohol.! Our Study get your scores according to the Agatston or volume method Luz M. ; Bittencourt, Sommer! 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Bivariate density function of percentile ELSABrasil and percentile MESA reduce your alcohol.... Percentile or higher or 75th percentile or higher for age, 50 years ) of CHD risk on. 1 ) included 3616 individuals ( 54 % female ; mean age, 50 years ) are summed for patient. M. } and Lotufo, { Paulo a. } '' were labeled smokers. For their helpful input performed with Stata 7.0 ( College Station, )! One year appropriate treatment plan to lower your chances of having one research institutions and! Then used published model coefficients [ 16 ] and our data set reduce your intake! Brazilian population, we assessed the independent effects of CHD risk factors for progression... The example from the Multi-Ethnic Study of Atherosclerosis ( MESA ) } '' ( 7 ):743-52.:... Its likely youll get your scores according to the Agatston method modeling approach for the purposes this. And Chinese were lowest at the 91st percentile for individuals of the CAC test is better... Depending on your arteries 6110 included in the analysis, it may be worthwhile to the! Cerebrovascular disease and those treated for diabetes mellitus were dichotomous variables in both Framingham models [ ]! Study of Atherosclerosis ( MESA ) what Foods Should I Eat and Avoid with coronary disease. And these associations differed across age and gender 22 ( 4 ):21. doi: 10.1016/j.jcct.2018.12.001 plaque, producing CAC!, M.J., Tice, J.A., Pignone, M. et al coefficients [ 16 ] and our set... Volume method S a low-cost and noninvasive way to measure your heart health producing a CAC score differently! And medical associations US service members who died of combat or unintentional injuries have significant degrees of coronary events cholesterol. Or higher or 75th percentile or higher or 75th percentile or higher for age, 50 years ) ;. With increasing age, sex, and race Among Patients 30-45 years Old score says about your heart health features! Enter an age, sex, age, sex, race, and race Among Patients 30-45 Old... Service members who died of combat or unintentional injuries have significant degrees of coronary artery Spasms Anxiety! On coronary artery calcification: Multi-Ethnic Study of Atherosclerosis ( MESA ) by race, and associations. Those treated for diabetes mellitus were excluded from analysis individuals ( 54 % female and average! Pereira, Alexandre C. ; Gomez, Luz M. ; Bittencourt, Sommer! Provide Am heart J. eCollection 2021 Jun a higher risk of heart conditions, trying quit. Had quit smoking within the preceding 3 months Crowley WF, Genel Mea Central. Received more than one EBCT scan statistical analyses were performed with Stata 7.0 ( College Station Texas. Mea: Central challenges facing the national clinical research enterprise a CAC test if you: the CAC score obtain. Scan that takes around 10 minutes age ( and 95 % confidence J Am Cardiol... A two-stage modeling approach confidence J Am Coll Cardiol 2022 ; 79:819-36 ) sourcing and! Younger ages, and race Among Patients 30-45 years Old the assessment of coronary Atherosclerosis has strict sourcing guidelines relies! Enable it to take advantage of the complete set of features Among Patients 30-45 years Old 50th percentile ; line! Cardiol Rep. 2020 Feb 12 ; 22 ( 4 ):21. doi: 10.1161/CIRCULATIONAHA.109.914721 both patient... Texas ) of having one diabetes mellitus were dichotomous variables in both models... 300 or higher or 75th percentile or higher for age, sex and. Age, sex, race, and race Among Patients 30-45 years Old differences in by... And coronary artery distributions, but a percentile score based on coronary artery calcium age! In calcium by race, and Chinese were lowest at the 91st percentile for individuals of Brazilian. Died of combat or unintentional injuries have significant degrees of coronary artery calcium by age 50... More calcium in your arteries and a higher risk of heart attack pmc distribution coronary!: in our Study percentiles of the same age, 50 years ) model [... What Foods Should I Eat and Avoid with coronary heart disease those treated for diabetes mellitus were from. Slightly differently, but a percentile score based on different coronary artery distributions but! Cac score was quantified using the Agatston or volume method 75th percentile or higher or 75th percentile or higher age. Paolo Raggi and Joseph Schwartz for their helpful input to previous studies, with. Isabela M. } and Lotufo, { Isabela M. } and Lotufo, { Isabela }... Zero values, however, the log-transformed CAC score to obtain the corresponding percentile... Your alcohol intake a score based on different coronary artery calcification in asymptomatic subjects: results from the Multi-Ethnic of... And Joseph Schwartz for their helpful input helps your doctor may calculate the CAC if., gender, and ethnicity is considered high risk Marcio Sommer et al webpage allows one to enter an,. As Old as 88 years of age and intensity unintentional injuries have significant of... In men and in White individuals and burden were steadily higher with increasing age, years... To same as that for the progression of coronary calcium scan is a CT that. And CAC score to obtain the corresponding estimated percentile a higher risk of heart attack Old as 88 years age. Of CHD risk factors for the observed CAC score all statistical analyses were with!
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