Recent research explores the role of coronary artery calcium (CAC) scans in predicting cardiovascular risk, particularly when used alongside the PREVENT risk calculator, a newly adopted tool that assesses the likelihood of future heart attacks and strokes. The findings, based on studies of data from over 6,000 participants followed for 10 years, suggest that while CAC scans provide value in certain situations, they are not universally necessary for all patients.
The PREVENT calculator uses standard clinical information such as blood pressure, cholesterol levels, age, and family history to classify risk into categories: low (under 3%), borderline (3% to 5%), intermediate (5% to 10%), and high (10% or higher). CAC scans measure calcium deposits in arteries on a scale from 0 to 1,000 or higher. Neither tool provides definitive guidance on statin therapy, which remains a decision for doctors and patients to make together. CAC scans typically cost between $100 and $400 and are not usually covered by insurance.
The two studies found that CAC scores added meaningful value specifically for patients in the borderline or intermediate risk categories, helping to clarify treatment decisions when it was unclear whether statin therapy should begin. However, for the general population, adding CAC screening to PREVENT risk assessment produced only modest improvements in predicting cardiovascular events. Notably, research published in Circulation in July also found that incidental calcium findings from CT scans performed for other reasons predicted heart disease outcomes just as effectively as dedicated CAC scans.
Researchers cautioned against using a CAC score of zero to avoid statin treatment, noting that some patients with zero calcium scores still experienced heart attacks or strokes within the following 10 years. Updated guidelines from the American College of Cardiology and American Heart Association recommend considering incidental calcium findings for men age 40 and up and women age 45 and up with borderline or intermediate risk, an expansion from prior guidance. Experts emphasized that CAC scans are most appropriately used to refine risk assessment near treatment thresholds rather than as a screening tool for all patients seeking personalized wellness measures.
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