From the Guidelines
Coronary calcium score testing should be repeated every 5 years for low-risk individuals or those with a CAC score of 0, according to the most recent guidelines from the ACC/AHA and CSANZ 1. When considering the frequency of coronary calcium score testing, several factors come into play, including the patient's initial CAC score, risk factors, and overall health status.
- For individuals with a CAC score of 0, the recommended repeat screening interval varies, but the ACC/AHA and CSANZ suggest 5 to 10 years 1.
- The ESC guidelines recommend that for CAC = 0, repeat screening should not be performed less than 5 years from the initial scan 1.
- For patients with diabetes or a CAC score between 101 and 400, the CSANZ recommends repeat CAC testing at 3 years 1.
- The NLA provides more specific guidance, recommending repeat scanning intervals based on a patient's baseline estimated ASCVD risk, ranging from 3 to 7 years 1. Key considerations in determining the frequency of coronary calcium score testing include the patient's risk factors, such as family history, high blood pressure, high cholesterol, diabetes, smoking, or obesity, as well as their overall health status and any changes in their condition.
- The test is generally advised for men aged 45-75 and women aged 55-75 who have risk factors but don't have known coronary artery disease.
- For those at low risk, the test may not be necessary at all, while those at high risk or with known heart disease may benefit more from other cardiac tests. The calcium score helps physicians assess the presence and extent of calcified plaque in coronary arteries, which correlates with total plaque burden and future cardiovascular risk, allowing for more targeted preventive strategies including lifestyle modifications and medication adjustments.
From the Research
Coronary Calcium Score Frequency
The frequency of coronary calcium score testing is not explicitly stated in the provided studies. However, the studies suggest that the test can be useful in guiding statin therapy allocation and assessing cardiovascular risk in certain populations.
Factors Influencing Testing Frequency
Several factors may influence the frequency of coronary calcium score testing, including:
- Age: A study published in 2021 2 suggests that the ideal age for initiating coronary artery calcium testing among at-risk young adults may be around 36.8 years for men and 50.3 years for women with diabetes.
- Risk factors: The presence of risk-enhancing factors such as family history of premature ASCVD, premature menopause, metabolic syndrome, chronic kidney disease, lipid and inflammatory biomarkers, and low ankle-brachial index may influence the frequency of testing 3.
- Hypercholesterolemia: A study published in 2023 4 suggests that coronary artery calcium scoring may be used to clarify risk in patients with severe hypercholesterolemia.
Testing Yield and Frequency
A testing yield of 25% for detecting CAC >0 may be used to determine the optimal age for a potential first scan 2. However, the frequency of subsequent testing is not explicitly stated in the provided studies.
Key Findings
Key findings from the studies include:
- Coronary artery calcium scoring can be used to guide statin therapy allocation and assess cardiovascular risk in certain populations 5, 6, 3.
- The presence of risk-enhancing factors may influence the frequency of testing 3.
- Age and risk factors may influence the ideal age for initiating coronary artery calcium testing 2.
- Coronary artery calcium scoring may be used to clarify risk in patients with severe hypercholesterolemia 4.