Calcium Score Impact in Primary Prevention

Coronary Artery Calcium Scoring (CAC) using non-contrast cardiac computed tomography is a validated, reproducible imaging technique that quantifies cummulative coronary atherosclerotic burden. Numerous large cohorts and meta-analyses consistently demonstrate a strong, graded association between CAC magnitude and future atherosclerotic cardiovascular disease events (ASCVD). Incremental risk is observed across CAC categories (0, 1-99, 100-399, >400), and each doubling of CAC confers approximately a 14% relative increase in event rate risk after adjustment for traditional risk factors. The power of zero (CAC=0) strongly rpedicts a very low short-to-intermediate-term event rate, but does not confer absolute protection, especially in high-risk phenotypes (eg smokers, diabetics, hypertensives, strong family history for CAD). Addition of CAC to clinical risk scores enhances stratification and reclassifies patients in the intermediate risk zone. In practice, CAC assists in refining statin or aspirin decision-making and patient communication for risk profile correction. Careful interpretation is required: CAC does not detect non-calcified plaque or ischemia, and management should be integrated with clinical context and other testing as appropriate.