University of Lynchburg DMSc Doctoral Project Assignment Repository
Abstract
Coronary artery calcium (CAC) scores are emerging as a reliable tool to better stratify risk in asymptomatic individuals with borderline to intermediate atherosclerotic cardiovascular disease (ASCVD). Traditional risk calculators provide population-based projections but may not fully capture individual atherosclerotic burden. This review outlines a practical framework for incorporating CAC scoring into clinical decision-making. A focused review of recent guidelines, cohort studies, and observational studies was conducted to evaluate the utility of CAC scoring in refining ASCVD risk assessment. Search terms included “coronary artery calcium”, “ASCVD risk stratification”, “coronary artery calcium and antiplatelet therapy”, and “statin therapy”.
The findings suggest that CAC scoring is a valuable noninvasive tool that enhances individualized risk assessment and supports more tailored preventive strategies. Higher CAC scores are associated with progressively greater ASCVD risk, whereas CAC scores of zero are linked to very low event rates over the same period. This proves that CAC scoring is an objective tool that may inform pharmacotherapy decisions, including initiation of HMG-CoA reductase inhibitors (statins) and selective consideration of antiplatelet therapy, while also enhancing shared decision making and lifestyle management. This personalized approach may help align preventive treatment more closely with an individual's actual cardiovascular risk.
Future research should focus on further defining how CAC can be incorporated into clinical algorithms. Areas of interest include determining whether CAC burden can guide the intensity of statins and whether CAC thresholds may inform selective antiplatelet therapy use in patients with borderline to intermediate ASCVD risk. Additional investigation is needed to establish appropriate intervals for repeat CAC testing and to determine whether certain patient
Recommended Citation
Tamerisa K. Coronary Artery Calcium Scoring: A Practical Framework for Clinical Decision Making. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2026; 8(1).
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