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October 15, 2025American Journal of Preventive CardiologyOpen Access

Coronary artery calcium is linked to ~19% higher ASCVD risk, improving standard risk prediction.

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Why the study?

Guidelines recommend considering CAC scoring in intermediate ASCVD risk patients, but its utility in lower-risk individuals remains less clear.

Does the addition of coronary artery calcium (CAC) scoring improve ASCVD risk prediction in low and borderline-risk individuals?

Population

6712 participants from MESA

Comparison

CAC scoring added to PCE and AHA PREVENT equations vs equations alone

Design

Prospective cohort study

Follow-up

Median of 16.7 years

Key result

The presence of coronary artery calcium was associated with increased ASCVD risk overall (HR 1.19) and in low-risk individuals (HR 1.35), significantly improving risk prediction when added to standard equations.

Authors

JDJonathan R. DavisARAlexander C. RazaviCECharlotte C Ellberg

Discussion

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Overview

May refine ASCVD stratification in low-risk patients; extends observational data but leaves adoption open pending trials.

Study Design

Type

Cohort (n=6,712)

Multicenter

Yes

Structured PICO

Does the addition of coronary artery calcium (CAC) scoring improve ASCVD risk prediction in low and borderline-risk individuals?

P
Population
6,712 participants from the Multi-Ethnic Study of Atherosclerosis (MESA), mean age 62.2 ± 10.2 years, 52.8% women.
I
Intervention
Coronary artery calcium (CAC) scoring added to pooled cohort equations (PCE) and AHA PREVENT equations
C
Comparator
Risk prediction using pooled cohort equations (PCE) and AHA PREVENT equations alone
O
Outcome
Association between CAC and ASCVD risk, and risk prediction improvement evaluated using Harrell's C-index and net reclassification improvement (NRI) over a median of 16.7 yearscomposite

Main Result

Effect estimate: HR 1.19 (95% CI 1.15-1.23)

Absolute Event Rate: 14.3% vs 4.1%

p-value: p=<0.001

The addition of coronary artery calcium scoring to standard risk equations significantly improves ASCVD risk prediction and reclassification in low- and borderline-risk individuals.

Limitations

  • Observational study subject to residual confounding
  • MESA participants may not be representative of the larger United States population
  • CAC density cannot be calculated unless CAC is present
  • Use of base 10-year AHA PREVENT equations instead of enhanced or 30-year equations

Cite This Study

Davis et al. (2025) conducted a cohort in Atherosclerotic cardiovascular disease risk (n=6,712). Coronary artery calcium (CAC) scoring (CAC > 0) vs. No coronary artery calcium (CAC = 0) was evaluated on ASCVD events (HR 1.19, 95% CI 1.15-1.23, p=<0.001). The presence of coronary artery calcium was associated with increased ASCVD risk overall (HR 1.19) and in low-risk individuals (HR 1.35), significantly improving risk prediction when added to standard equations.

synapsesocial.com/papers/6a0f2c5d4045c7e590426c88https://doi.org/10.1016/j.ajpc.2025.101329
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