TOPLINE

Adding coronary artery calcium (CAC) scoring to risk estimates helped better identify adults at lower and higher risk for atherosclerotic cardiovascular disease (ASCVD) events. People with no detectable CAC had lower observed risk, while those with CAC had higher observed risk, especially when the decision about starting a statin was uncertain.

METHODOLOGY

• Researchers analyzed data from a US community-based cohort (MESA) to evaluate how CAC relates to ASCVD event rates across risk categories and groups of statin eligibility.
• The analysis included 5698 adults without clinical ASCVD at baseline (mean age, 61.5 years; 52.8% women).
• All participants underwent cardiac CT CAC scoring at baseline, which was categorized as 0, 1-99, or ≥ 100. Participants were also grouped based on the presence or absence of CAC ( CAC = 0 vs CAC > 0).
• Researchers calculated 10-year PREVENT-ASCVD risk, defined four risk tiers (< 3%, 3% to < 5%, 5% to < 10%, ≥ 10%), and categorized statin eligibility as not recommended, considered, or recommended per the 2026 dyslipidemia guideline of the American College of Cardiology/American Heart Association.
• The outcome was incident ASCVD captured over 10 years.

TAKEAWAY

• Participants not recommended for statins had 10-year ASCVD event rates of 1.2 per 1000 person-years with CAC = 0 vs 4.5 per 1000 person-years with CAC > 0.
• Participants in the statin-considered group had 10-year ASCVD event rates of 2.7 per 1000 person-years with CAC = 0 and 5.2 per 1000 person-years with CAC > 0; those in the statin-recommended group had rates of 5.8 and 16.6 per 1000 person-years, respectively.
• In participants with low-density lipoprotein-cholesterol levels of 70-189 mg/dL and no diabetes, CAC > 0 was linked to about twofold or higher event rates across PREVENT risk tiers.
• Addition of CAC to PREVENT-based risk categories resulted in a categorical net reclassification improvement of 0.124, driven by appropriate reclassification of events and nonevents.

IN PRACTICE

“CAC may be most useful for contextualizing absolute risk and guiding the intensity of preventive efforts within contemporary prevention frameworks,” the researchers wrote.

SOURCE

This study was led by Rishi Rikhi, MD, MS, Wake Forest University School of Medicine, Winston-Salem, North Carolina. It was published online on July 15 in JACC.

LIMITATIONS

Researchers used baseline MESA data to calculate PREVENT risk, which may not have reflected current distributions of risk factors. CAC results were not blinded to clinicians or participants. MESA was a relatively healthy primary prevention cohort, which may have led to lower absolute rates of ASCVD events.

DISCLOSURES

This study received support from the National Heart, Lung, and Blood Institute and the National Center for Advancing Translational Science. Several authors reported receiving government research contracts and institutional or investigator grants from pharmaceutical, device, or biotechnology companies. Some authors reported receiving consulting fees, honoraria, participation on scientific or advisory boards, and industry-sponsored research support. One author reported owning equity in a health-related company.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.