Coronary Artery Calcium Measurement to Assist in Primary Prevention Decisions for Aspirin and Lipid-Lowering Therapies

Purpose of Review We evaluated the role of CAC in guiding primary prevention with lipid-lowering medications and aspirin. Recent Findings Zero CAC is associated with low risk of future CVD events. Statin use does not weaken the prognostic utility of CAC. CAC scoring has clinical utility in patients with severe primary hypercholesteremia, hypertension, diabetes/metabolic syndrome, and in the young and older adults. The timing for repeat CAC measurement depends on baseline ASCVD risk and generally varies from 3 to 7 years. Summary CAC is a cost-effective risk stratification approach useful in guiding shared clinical decision-making regarding allocation, intensification, and delay in primary prevention pharmacotherapies. The role of CAC in streamlining the next generation of primary prevention RCTs must be explored. The next frontier in primary prevention is the focus on tailored treatment of the unique group of patients with "advanced subclinical atherosclerosis" as identified by CAC.