From the Guidelines
Patients with a coronary artery calcium score of 173 should be considered for aspirin therapy as part of a comprehensive cardiovascular risk reduction strategy, given the score is above 100, which is often recommended for low-dose aspirin (81 mg daily) in guidelines such as those from the American SCCT and NLA 1. The decision to initiate aspirin therapy in a patient with a significant coronary artery calcium (CAC) score, such as 173, requires careful consideration of the patient's overall cardiovascular risk versus bleeding risk. Key factors to consider include:
- Age
- Blood pressure
- Cholesterol levels
- Diabetes status
- Smoking history
- History of gastrointestinal bleeding
- Use of anticoagulants
- Older age (>70 years) Aspirin works by inhibiting platelet aggregation, thereby reducing the risk of arterial thrombosis that could lead to heart attacks. The presence of coronary calcium indicates atherosclerotic plaque, and aspirin may help prevent plaque rupture and subsequent thrombotic events. This preventive therapy should always be implemented alongside lifestyle modifications including diet, exercise, smoking cessation, and management of other risk factors like hypertension and hyperlipidemia. Recent guidelines, such as the 2024 ESC guidelines for the management of chronic coronary syndromes, support the use of low-dose aspirin (75–100 mg once daily) in patients with coronary artery disease, highlighting its effectiveness in reducing the combined risk of non-fatal MI, non-fatal ischemic stroke, or death from vascular causes 1. However, the most recent and highest quality study, the major global coronary artery calcium guidelines from 2023, emphasizes the importance of CAC in guiding aspirin therapy, suggesting that patients with CAC scores ≥100 may benefit from aspirin therapy, especially if they do not have bleeding-related contraindications 1. Therefore, for a patient with a CAC score of 173, aspirin therapy is likely beneficial, but the decision should be individualized based on a comprehensive assessment of the patient's risk factors and potential for bleeding complications.
From the Research
Aspirin Therapy for Patients with Coronary Artery Calcium Score
- A patient with a coronary artery calcium (CAC) score of 173 is considered to have a significant coronary atherosclerotic burden 2.
- The use of aspirin in patients with a high CAC score is supported by studies that demonstrate its effectiveness in reducing the risk of major cardiovascular outcomes, especially in asymptomatic individuals 3.
- Aspirin therapy, in combination with statins and blood pressure-lowering agents, has been shown to be associated with a lower risk of vascular events and total mortality in patients with coronary artery disease 4, 5.
- The CAC score can be used to guide the decision to initiate aspirin therapy, as it provides a measure of the overall coronary atherosclerotic burden and can help identify individuals who are at high risk of cardiovascular events 3, 2.
- The Agatston score of 173 corresponds to a significant coronary atherosclerotic burden, and aspirin therapy may be considered as part of a comprehensive prevention strategy, including statin therapy and lifestyle modifications, to reduce the risk of cardiovascular events 3, 6.