Coronary Artery Calcium in Primary Prevention

Background: Identifying high-risk asymptomatic individuals remains the cornerstone of cardiovascular disease prevention. Coronary artery calcium is a highly specific marker of atherosclerosis that can be quantified using non-contrast computed tomography. The resulting calcium score has the capacity to improve current methods of risk stratification.

Objective: The aim of this article is to provide an overview of calcium scoring, including its method of acquisition, indications, interpretation and role in prognostication.

Discussion: Calcium score has been shown to convincingly predict future cardiovascular risk in the asymptomatic population across a wide range of ethnicities, ages and sexes. Individuals at intermediate Framingham risk benefit the most from calcium scoring, which can be used to inform the need for preventive pharmacotherapy. Calcium scoring can be repeated after five years to reassess cardiovascular risk, especially when there is a decision to defer statin therapy on the basis of absence of coronary calcium.