Prevention
Coronary artery calcium (CAC) score
Interprets the Agatston coronary calcium score with the CAC-DRS categories. Guides statin intensity under ACC/AHA 2018, and from 300 AU adds the ACC/AHA 2026 and ESC 2021 LDL-C goals. Applies the MESA evidence that low-dose aspirin gives net benefit only when CAC is at least 100 and bleeding risk is low. Flags patients with CAC under 100 who carry more risk than the number suggests: left main calcium, calcium in three or more vessels, or high-risk plaque on CCTA.
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Coronary artery calcium
Non-contrast gated CT, Agatston method
Distribution and plaque
Can move CAC < 100 into a higher-risk group
Vessels with calcium
Clinical modifiers
Coronary artery calcium
Enter the Agatston score.
References
- Grundy SM, et al. 2018 AHA/ACC/multisociety guideline on the management of blood cholesterol. Circulation 2019;139:e1082-e1143.
- Arnett DK, et al. 2019 ACC/AHA Guideline on the primary prevention of cardiovascular disease. Circulation 2019;140:e596-e646.
- Blumenthal RS, Morris PB, Gaudino M, et al. 2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the management of dyslipidemia. J Am Coll Cardiol 2026.
- Visseren FLJ, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J 2021;42:3227-3337.
- Hecht HS, et al. CAC-DRS: Coronary Artery Calcium Data and Reporting System. An expert consensus document of the Society of Cardiovascular Computed Tomography (SCCT). J Cardiovasc Comput Tomogr 2018;12:185-191.
- Miedema MD, et al. Use of coronary artery calcium testing to guide aspirin utilization for primary prevention: estimates from the Multi-Ethnic Study of Atherosclerosis. Circ Cardiovasc Qual Outcomes 2014;7:453-460.
- Cainzos-Achirica M, et al. Coronary artery calcium for personalized allocation of aspirin in primary prevention of cardiovascular disease in 2019: the MESA study. Circulation 2020;141:1541-1553.
- Blaha MJ, et al. Improving the CAC score by addition of regional measures of calcium distribution: Multi-Ethnic Study of Atherosclerosis. JACC Cardiovasc Imaging 2016;9:1407-1416.
- Williams MC, et al. Low-attenuation noncalcified plaque on coronary CT angiography predicts myocardial infarction: results from the SCOT-HEART trial. Circulation 2020;141:1452-1462.