Guideline-Directed Application of Coronary Artery Calcium Scores for Primary Prevention of Atherosclerotic Cardiovascular Disease (JIMG April 2025)-Article: Guideline-Directed Application of Coronary Artery Calcium Scores for Primary Prevention of Atherosclerotic Cardiovascular Disease

Article: Guideline-Directed Application of Coronary Artery Calcium Scores for Primary Prevention of Atherosclerotic Cardiovascular Disease

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The study examines the use of coronary artery calcium (CAC) scores in guiding primary prevention of atherosclerotic cardiovascular disease (ASCVD) based on American College of Cardiology/American Heart Association (ACC/AHA) and European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines. CAC scores, a measure of calcification in the coronary arteries, have been established as strong predictors of cardiovascular events, surpassing traditional risk factors.<br /><br />The research involved 1903 participants aged 55-75 from the Rotterdam Study, excluding those with diabetes or history of ASCVD, and evaluated the proportion eligible for CAC scans based on guidelines. Using ACC/AHA guidelines, 18.3% of men and 11.9% of women were eligible for CAC scans with Pooled Cohort Equations (PCE), and fewer with the PREVENT equations. In contrast, the ESC/EAS guidelines indicated a larger pool, with about 46.6% of men and 44.9% of women eligible for CAC scans. <br /><br />Key findings reveal that CAC scores aid in reclassifying risk categories. Importantly, those with intermediate risk but significant CAC detected were uprisked to statin therapy recommendation, while those with zero scores, particularly women, often saw downgrading in risk categories due to the score's negative predictive value.<br /><br />The study supports CAC’s utility in ASCVD risk refinement, suggesting it identifies patients who might benefit from statins more efficiently, with acceptable numbers needed to treat (NNT) based on high-intensity statin therapy. It highlights disparities in guidelines but underscores CAC’s role in enhancing decision-making concerning starting statins for prevention. Future trials are expected to further direct the optimal integration of CAC scoring into cardiovascular risk assessment protocols, potentially informing global standardized guidelines.

Keywords

coronary artery calcium

atherosclerotic cardiovascular disease

ACC/AHA guidelines

ESC/EAS guidelines

Rotterdam Study

CAC scores

statin therapy

risk reclassification

cardiovascular risk assessment

guideline disparities