Highlights

• CAC scoring strongly informs ASCVD risk discrimination and reclassification.
• CAC scoring aids in ASCVD risk prediction, regardless of race, gender or ethnicity.
• CAC scoring aids the clinician to allocate statin therapy based on ASCVD risk.
• Very high CAC scores may inform decision-making about add-on therapies to statins.
• CAC scoring aids decision-making about aspirin and anti-hypertensive therapy.

Abstract

An Expert Panel of the National Lipid Association reviewed the evidence related to the use of coronary artery calcium (CAC) scoring in clinical practice for adults seen for primary prevention of atherosclerotic cardiovascular disease. Recommendations for optimal use of this test in adults of various races/ethnicities, ages and multiple domains of primary prevention, including those with a 10-year ASCVD risk <20%, those with diabetes or the metabolic syndrome, and those with severe hypercholesterolemia were provided. Recommendations were also made on optimal timing for repeat calcium scoring after an initial test, use of CAC scoring in those taking statins, and its role in informing the clinician patient discussion on the benefit of aspirin and anti-hypertensive drug therapy. Finally, a vision is provided for the future of coronary calcium scoring.