Role of Coronary Calcium for Risk Stratification and Prognostication

A multitude of studies now support the understanding that an increased coronary artery calcium (CAC) score represents advanced atherosclerosis and high risk for cardiovascular disease (CVD) and, as such, should be treated with conventional therapies for those considered high risk. Data is now available to guide treatment with aspirin, statins, and lifestyle management. The new ACC/AHA 2013 guidelines support intensifying statin therapy when the CAC is ≥75th percentile for age, sex, and ethnicity/race or when the calcium score is ≥300 Agatston units. This allows for aggressive management of those at the highest risk, matching intensity of therapy with intensity of risk. Most importantly, the asymptomatic person rarely needs to undergo evaluation for obstructive disease, even when CAC scores are high, as revascularization with percutaneous coronary interventions does not improve outcomes in asymptomatic persons with preserved left ventricular function. Treatment should be relegated to improvement in lifestyle, diet, exercise, aspirin, statins, and blood pressure control.