What is the risk stratification for Coronary Artery Calcification (CAC) scores?

From the Guidelines

Coronary artery calcium (CAC) scores are stratified into risk categories, with a CAC score of 0 indicating no detectable calcium and very low risk, scores of 1-100 representing mild calcification with low to moderate risk, scores of 101-400 indicating moderate to high risk, and scores >400 representing extensive calcification with very high risk. The risk stratification for CAC scores is based on the latest guidelines, including the 2023 major global coronary artery calcium guidelines 1.

Key Points

• A CAC score of 0 suggests withholding statin therapy, while a CAC score of 1 to 100 favors lifestyle improvement 1.
• A CAC score of 101 to 400 indicates treatment for individuals >75th percentile, and a CAC score >400 requires initiation of statin therapy 1.
• The CAC score is a strong predictor of cardiovascular risk, with higher scores indicating a higher risk of cardiovascular events 1.
• The use of CAC scoring can help personalize risk assessment and guide preventive strategies, particularly for patients at intermediate risk by conventional assessment methods 1.

Clinical Implications

• For patients with CAC scores ≥100, statin therapy is typically recommended regardless of other risk factors 1.
• Those with scores ≥300 may benefit from more intensive lipid-lowering therapy and closer monitoring 1.
• CAC scoring provides direct visualization of subclinical atherosclerosis, offering a more personalized risk assessment than traditional risk calculators alone 1.

Decision Making

• The decision to use statin therapy or other preventive interventions should be based on the CAC score, as well as other risk factors and clinical considerations 1.
• The CAC score can help clinicians determine the appropriate level of risk factor modification and preventive interventions for each patient 1.

From the Research

Risk Stratification for CAC Scores

The risk stratification for Coronary Artery Calcium (CAC) scores is a method used to assess the risk of cardiovascular events. The following points highlight the key aspects of CAC score risk stratification:

• CAC scoring is used to stratify acute coronary syndrome (ACS) risk, with patients having a CAC score of zero (CAC0) still at risk from noncalcified plaque components 2.
• The CAC score is a highly specific feature of coronary atherosclerosis and is used to assess risk for major cardiovascular outcomes, especially in asymptomatic people 3.
• Low values of high-sensitivity cardiac troponin (hs-cTn) and CAC scores of zero are associated with a low risk for atherosclerotic cardiovascular disease (ASCVD) 4.
• The addition of CAC to traditional risk factors improves risk stratification in CVD risk categories, especially among individuals at intermediate risk for CVD 5.
• Long-term statin therapy is associated with severe coronary artery calcification, which may affect the interpretation of cardiovascular event risk 6.

CAC Score Categories

The CAC scores can be categorized into different levels of risk, including:

• CAC score of zero (CAC0), which is associated with a low risk of ASCVD 4.
• CAC score greater than zero (CAC>0), which is associated with a higher risk of ASCVD 4.
• Severe CACS (≥400 AU), which is associated with a higher risk of cardiovascular events 6.

Clinical Implications

The risk stratification for CAC scores has important clinical implications, including:

• Identifying individuals at high risk for cardiovascular events and initiating adequate treatment 3.
• Refraining from unneeded therapy in low-risk individuals 5.
• Adjusting the interpretation of cardiovascular event risk in the context of chronic statin therapy 6.