Coronary Artery Calcium: Recommendations for Risk Assessment in Cardiovascular Prevention Guidelines

Mahmoud Al Rifai, Miguel Cainzos-Achirica, Sina Kianoush, Mohammadhassan Mirbolouk, Alison Peng, Josep Comin-Colet, Michael J. Blaha

Research output: Contribution to journalReview articlepeer-review

17 Scopus citations


Purpose of review: In this review, we evaluate the coronary artery calcium (CAC) score as a biomarker for advanced atherosclerotic cardiovascular disease (ASCVD) risk assessment. Recent findings: We summarize the evidence from multiple epidemiological studies, which show a clear advantage of CAC compared to traditional and non-traditional cardiovascular risk factors. We then compare the recommendations included in the 2013 American College of Cardiology/American Heart Association (ACC/AHA) and in the 2017 Society of Cardiovascular Computed Tomography (SCCT) guidelines for the use of CAC in ASCVD risk assessment, and examine the recent 2018 US Preventive Services Task Force (USPSTF) document. Finally, based on the currently available evidence, we provide constructive input for the upcoming ACC/AHA guidelines, regarding the population in whom CAC is most likely to be informative, the level of evidence that we believe should be assigned to CAC as an advanced ASCVD risk assessment tool, and the special populations in whom CAC might be beneficial for further risk assessment. Summary: We support a pragmatic approach that combines the pooled cohort equations (PCE) for initial ASCVD risk stratification, followed by CAC for refining ASCVD risk assessment among a broad range of intermediate risk patients and other special groups.

Original languageEnglish (US)
Article number89
JournalCurrent Treatment Options in Cardiovascular Medicine
Issue number11
StatePublished - Nov 1 2018


  • Atherosclerotic cardiovascular disease
  • Coronary artery calcium
  • Prevention
  • Risk assessment
  • Statins

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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