Coronary Artery Calcium: Benefits Beyond Current Clinical Recommendations.

Coronary artery calcium (CAC) is a highly specific marker of subclinical atherosclerosis and an extensively studied mediator of atherosclerotic cardiovascular disease. The presence of CAC clearly identifies asymptomatic subjects who are at risk for future coronary heart disease (CHD) events. 1 Detrano R Guerci AD Carr JJ Bild DE Burke G Folsom AR Liu K Shea S Szklo M Bluemke DA O'Leary DH Tracy R Watson K Wong ND Kronmal RA Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med. 2008; 358: 1336-1345 Google Scholar A CAC score of 0 is also equally important, as its absence reclassifies subjects as ineligible for statin therapy. 2 Nasir K Bittencourt MS Blaha MJ Blankstein R Agatson AS Rivera JJ Miedema MD Sibley CT Shaw LJ Blumenthal RS Budoff MJ Krumholz HM. Implications of coronary artery calcium testing among statin candidates according to American College of Cardiology/American Heart Association cholesterol management guidelines: MESA (Multi-Ethnic Study of Atherosclerosis). J Am Coll Cardiol. 2015; 66: 1657-1668 Google Scholar Accordingly, CAC scoring has been implemented in recent prevention guidelines. 3 Grundy SM Stone NJ Bailey AL Beam C Birtcher KK Blumenthal RS Braun LT de Ferranti S Faiella-Tommasino J Forman DE Goldberg R Heidenreich PA Hlatky MA Jones DW Lloyd-Jones D Lopez-Pajares N Ndumele CE Orringer CE Peralta CA Saseen JJ Smith Jr, SC Sperling L Virani SS Yeboah J 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019; 73: e285-e350 Google Scholar In intermediate-risk or selected borderline-risk adults CAC scoring is recommended for further risk stratification to determine if it is reasonable to withhold or initiate statin therapy. 3 Grundy SM Stone NJ Bailey AL Beam C Birtcher KK Blumenthal RS Braun LT de Ferranti S Faiella-Tommasino J Forman DE Goldberg R Heidenreich PA Hlatky MA Jones DW Lloyd-Jones D Lopez-Pajares N Ndumele CE Orringer CE Peralta CA Saseen JJ Smith Jr, SC Sperling L Virani SS Yeboah J 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019; 73: e285-e350 Google Scholar High-risk populations, including patients with diabetes mellitus, were excluded from this recommendation, as statin therapy was already recommended.