Coronary Artery Calcium in Primary Prevention

Without question, CAC scanning is one of the most important diagnostic achievements in the primary prevention of coronary heart disease in the past generation. Every study, whether retrospective, self-referred, or based on a prospective population, has consistently and conclusively shown CAC to be the most powerful predictor of risk in asymptomatic patients, outperforming carotid intima media thickness, brachial artery reactivity, ankle brachial index, and serum biomarkers, including C-reactive protein. It consistently adds incremental and independent predictive value to risk calculators (ie-Framingham Risk or Pooled Risk Cohort) for future ASCVD events. CAC has a strong influence to improving adherence to statin medications, aspirin, diet, and exercise programs. This has been consistently demonstrated, with greater adherence reflecting higher CAC scores. Finally, non-coronary calcifications (ie-thoracic aorta and valve calcification) have been demonstrated to add important prognostic and diagnostic information related to the cardiac patient. Thus, coronary artery calcium is a robust, easy to perform, low radiation test, that is increasingly being used as a screening test in asymptomatic persons to identify those with advanced atherosclerosis who would benefit from preventive therapies.