Coronary Calcium Score and the New Guidelines Back to Square One? ∗

Previous guidelines for cardiovascular risk assessment recommended the use of a modified Framingham score to estimate the 10-year risk of hard coronary heart disease (CHD) events, defined as myocardial infarction and CHD death (1). Coronary artery calcium (CAC) scoring for refined stratification received Class IIa or IIb recommendations for those at intermediate (10% to 20%) or low to intermediate (6% to 10%) risk, respectively (2). In 2013, the American College of Cardiology (ACC) and American Heart Association (AHA) released guidelines (3,4) endorsing new sex- and race-specific predictive equations derived from 5 large prospective cohorts, using conventional risk factors, and estimating 10- or 30-year risks of major atherosclerotic cardiovascular disease (ASCVD) events (also including stroke). The new guidelines advocate initiation or consideration of statin therapy based on absolute 10-year risk thresholds of ≥7.5% or 5% to 7.5%, respectively, as determined by these equations. CAC scoring is considered if uncertainty remains after conventional risk assessment (Class IIb recommendation).
Source: Journal of the American College of Cardiology - Category: Cardiology Source Type: research