Key result
CACS testing reclassifies ~42% of asymptomatic adults vs ASCVD equations alone, increasing statin initiation.
Why the study?
CACS provides a direct measure of subclinical atherosclerosis with strong prognostic value beyond conventional cardiovascular risk equations, prompting evaluation of its impact on risk reclassification and statin initiation.
Does CACS testing alter risk reclassification and statin treatment decisions compared to conventional ASCVD risk equations alone in asymptomatic middle-aged adults?
Observational (n=380)
Does CACS testing alter risk reclassification and statin treatment decisions compared to conventional ASCVD risk equations alone in asymptomatic middle-aged adults?
CACS testing significantly reclassifies cardiovascular risk and alters statin prescribing patterns in asymptomatic middle-aged adults, supporting its use in shared decision-making for primary prevention.
Answers are grounded in this paper and cite their sources.
CACS-guided statin decisions should not yet change practice; leaves open whether reclassification improves outcomes in primary prevention.
Coronary artery calcium score (CACS), measured by non-contrast cardiac CT, provides a direct measure of subclinical atherosclerosis with strong prognostic value beyond conventional cardiovascular risk equations. We assessed the impact of CACS testing on risk reclassification and statin initiation in 380 asymptomatic middle-aged adults (198 men, 182 women) referred from primary care for cardiovascular risk assessment. Most participants (152, 40.0%) had a CACS of zero, while 70 (18.4%) had a score above 300. Compared with the conventional pooled-cohort ASCVD risk equation alone, the addition of CACS reclassified 41.6% of participants 23.2% downward to a lower treatment-decision category and 18.4% upward. Statin initiation among intermediate-risk participants rose from 42% before CACS testing to 68% after, while statin de-escalation occurred in 47 patients (12.4%) with CACS of zero who had previously been on therapy. CACS testing meaningfully reshaped treatment decisions in a real-world preventive cardiology population and supports its incorporation into shared decision-making for primary prevention.
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Sylonia et al. (2026) conducted an observational in Subclinical atherosclerosis (n=380). Coronary artery calcium score (CACS) testing vs. Conventional pooled-cohort ASCVD risk equation was evaluated on Risk reclassification. Coronary artery calcium score testing reclassified 41.6% of asymptomatic middle-aged adults compared to ASCVD risk equations alone, increasing statin initiation in intermediate-risk patients to 68%.
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