From the Guidelines
The current indicated use for Computed Tomography (CT) calcium score is to assess cardiovascular risk in asymptomatic individuals with intermediate risk of coronary artery disease, particularly those with a 10-year risk of 5% to 7.5% and risk-enhancing factors, as it provides incremental prognostic information beyond conventional risk factors 1. The CT calcium score is a valuable tool for risk stratification, as it quantifies the amount of calcified plaque in coronary arteries, with higher scores indicating greater atherosclerotic burden and increased risk of future cardiac events.
- Key points to consider when using CT calcium scoring include:
- The test is particularly useful for patients aged 40-75 with risk factors such as family history of heart disease, hypertension, diabetes, smoking, or dyslipidemia, but without established cardiovascular disease.
- A score of zero suggests very low risk, while scores above 300 indicate high risk.
- The test helps clinicians make more informed decisions about preventive therapies like statins, aspirin, or lifestyle modifications.
- CT calcium scoring is non-invasive, requires no contrast, and delivers relatively low radiation exposure.
- It should not be used for patients with known coronary artery disease, those already taking statins, or as a screening tool for low-risk individuals.
- The value of this test lies in its ability to reclassify risk in intermediate-risk patients, potentially changing management strategies based on more personalized risk assessment, as demonstrated by studies such as the MESA and the Heinz Nixdorf Recall study 1. Some of the key evidence supporting the use of CT calcium scoring includes:
- The study by Kondos et al, which found that any measurable coronary calcium was independently related to hard and soft events in men and women at low to intermediate pretest risk 1.
- The study by Shaw et al, which found that a CAC score was an independent predictor of death that increased proportionally relative to baseline 1.
- The recent AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline, which suggests that patients with a 10-year risk of 5% to 7.5% and risk-enhancing factors may benefit from a CAC score prior to initiating statin therapy 1.
From the Research
Current Indicated Use for Computed Tomography (CT) Calcium Score
The current indicated use for Computed Tomography (CT) calcium score is for risk stratification in primary prevention of cardiovascular events, particularly in individuals with intermediate risk [ 2, 3,4,5,6 ].
- The CT calcium score is a marker of atherosclerotic plaque burden and an independent predictor of future myocardial infarction and mortality [ 2, 3,4,5,6 ].
- It provides incremental risk information beyond traditional risk calculators, such as the Framingham Risk Score [ 2, 4 ].
- The use of CT calcium scoring is recommended for asymptomatic patients with an intermediate risk for coronary artery disease 3, 4, 5.
- A zero CT calcium score confers a very low risk of death, while higher scores are associated with an increased risk of cardiovascular events [ 2, 3,4,5,6 ].
Patient Groups to Consider for CT Calcium Scoring
The following patient groups should be considered for CT calcium scoring:
- Asymptomatic patients with intermediate risk for coronary artery disease 3, 4, 5
- Patients with a borderline 10-year risk in the range of 5%-7.5% 4
- Patients with a family history of cardiovascular disease [ 2 ]
Management Recommendations Based on CT Calcium Score
Management recommendations based on CT calcium score include:
- Optimal diet and lifestyle measures for all risk groups [ 2 ]
- Preventative medical therapy, such as aspirin and statins, for patients with moderately-high or high risk based on CT calcium score [ 2, 4 ]
- Repeat CT calcium testing may be considered in 5 years for patients with a CT calcium score of 0, but not sooner [ 2 ]