Coronary Artery Calcium Clinical Utilization: An Update

Coronary artery disease (CAD) remains a leading cause of mortality and morbidity worldwide. Coronary artery calcification (CAC) is a well-established marker of atherosclerotic burden, and its quantification provides an objective measure of subclinical coronary atherosclerosis that can refine cardiovascular risk stratification and guide decisions regarding risk factor modification and lipid-lowering therapies. There is extensive data supporting the role of CAC scoring as an adjunct risk refinement tool, and it has been incorporated into multiple primary prevention guidelines. In addition to the Agatston method, CAC can also be quantified using non-gated computed tomography (CT) scans which are simple and widely available from non-cardiac screening strategies, including those obtained routinely for lung cancer screening. The integration of artificial intelligence and automated CAC assessment in non-gated studies is further expanding its application for risk stratification to a much larger population. This review summarizes the current tools, evidence and guidelines supporting the use of CAC to help risk stratify, optimize lipid lowering therapy, and potentially improve patient outcomes.