From the Guidelines
Cardiac calcium scores should be done every 5 years for individuals with a low to intermediate risk of heart disease, while those with high risk or established coronary artery disease may require more frequent or individualized testing. The decision to perform cardiac calcium scoring should be based on a patient's baseline estimated ASCVD risk, with varying repeat scanning intervals recommended by different guidelines 1. For example, the NLA recommends repeat scanning intervals of 5 to 7 years for low-risk patients, 3 to 5 years for borderline- to intermediate-risk patients, and 3 years for high-risk or diabetes patients 1.
When considering the timing of repeat cardiac calcium scoring, it's essential to weigh the benefits of monitoring coronary artery calcification against the risks of radiation exposure and limited incremental value from frequent testing 1. The initial calcium score provides important baseline information, which helps physicians assess cardiovascular risk and guide preventive strategies. Individuals with low risk generally don't need calcium scoring, while those at high risk may benefit more from other cardiac tests.
Key factors to consider when determining the frequency of cardiac calcium scoring include:
- Baseline estimated ASCVD risk
- Presence of risk factors such as diabetes, family history of ASCVD, or chronic inflammatory conditions
- Initial calcium score and presence of coronary artery calcification
- Patient's age and overall health status
- Guidance from relevant clinical guidelines, such as those from the ACC/AHA, CSANZ, ESC, and NLA 1.
Ultimately, the decision to perform cardiac calcium scoring should be individualized based on a patient's specific risk profile, family history, and other cardiovascular risk factors 1.
From the Research
Frequency of Cardiac Calcium Scores
The frequency of cardiac calcium scores is not explicitly stated in the provided studies. However, the studies suggest that cardiac calcium scores can be a useful tool in assessing cardiovascular risk and guiding treatment decisions.
Key Findings
- Cardiac calcium scores can help reclassify risk upward or downward in approximately 50% of intermediate-risk patients 2.
- The addition of cardiac calcium scores to traditional cardiovascular risk assessment equations can provide some further discrimination, but the gain may be modest and outweighed by costs, rates of incidental findings, and radiation risks 3.
- Cardiac calcium scores have been shown to outperform conventional risk factors, highly sensitive C-reactive protein, and carotid intima media thickness as a predictor of cardiovascular events 4.
- The use of cardiac calcium scoring can be associated with significant improvements in the reclassification and discrimination of incident atherosclerotic cardiovascular disease 5.
- Cardiac calcium scoring has emerged as a widely available, consistent, and reproducible means of assessing risk for major cardiovascular outcomes, especially useful in asymptomatic people for planning primary prevention interventions 6.
Considerations for Cardiac Calcium Scores
- The decision to initiate or intensify statin therapy may be uncertain across a broad range of estimated 10-year atherosclerotic cardiovascular disease risk of 5% to 20%, and cardiac calcium testing can help inform the risk discussion 2.
- Cardiac calcium scores may be most useful in intermediate-risk patients, as they can help identify increased risk and motivate effective behavioral changes 4.
- The presence of risk-enhancing factors, such as family history of premature atherosclerotic cardiovascular disease, premature menopause, metabolic syndrome, chronic kidney disease, lipid and inflammatory biomarkers, and low ankle-brachial index, may not be associated with an overall atherosclerotic cardiovascular disease risk that is higher than the recommended treatment threshold for the initiation of statin therapy in patients with a cardiac calcium score of 0 5.