Lexicon
Coronary Artery Calcium
Also known as CAC score, Calcium score, CAC, Agatston score
Definition
Coronary artery calcium (CAC) is a highly specific feature of coronary atherosclerosis. [1] CAC is a known marker for coronary heart disease and a useful tool for estimating the risk of atherosclerotic cardiovascular disease. [2]
How it works
On the basis of single-center and multicenter clinical and population-based studies with follow-up up to 15 years, CAC scoring has emerged as a consistent and reproducible means of assessing risk for major cardiovascular outcomes. [1] Higher CAC density is inversely associated with plaque vulnerability and, after adjustment for risk factors and CAC volume, with a lower risk of cardiovascular events (HR 0.80 per SD of density, 95% CI 0.72-0.89). [3]
Connected concepts
How it's measured
What levels mean
If the coronary artery calcium score is zero, it is reasonable to withhold statin therapy and reassess in 5 to 10 years, as long as higher-risk conditions are absent. [4] If the coronary artery calcium score is 1 to 99, it is reasonable to initiate statin therapy for patients 55 years of age or older. [4] If the coronary artery calcium score is 100 or higher or in the 75th percentile or higher, it is reasonable to initiate statin therapy. [4] In adults with elevated LDL Cholesterol whose statin decision remains uncertain after risk assessment, guidelines advise measuring coronary artery calcium, using the score to withhold, delay, or favor initiation of LDL Cholesterol-lowering statin therapy [5]
Community knowledge
## CAC Scoring and Plaque Imaging
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- 1.Greenland P, Blaha MJ, Budoff MJ, Erbel R, Watson KE. Coronary Calcium Score and Cardiovascular Risk. J Am Coll Cardiol · 2018
- 2.Aromiwura AA, Kalra DK. Artificial Intelligence in Coronary Artery Calcium Scoring. J Clin Med · 2024
- 3.Yong Y, Giovannucci J, Pang SN, Hong W, Han D, Berman DS, Dey D, Nicholls SJ. Coronary Artery Calcium Density and Risk of Cardiovascular Events: A Systematic Review and Meta-Analysis. JACC Cardiovasc Imaging · 2025
- 4.Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, Himmelfarb CD, Khera A. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation · 2019
- 5.Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, Braun LT, de Ferranti S, Faiella-Tommasino J, Forman DE, Goldberg R, Heidenreich PA, Hlatky MA, Jones DW, Lloyd-Jones D, Lopez-Pajares N, Ndumele CE, Orringer CE, Peralta CA, Saseen JJ, Smith SC, Sperling L, Virani SS, Yeboah J. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
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