Preventing ASCVD Events: Using Coronary Artery Calcification Scores to Personalize Risk and Guide Statin Therapy

Background: Lung cancer is the most common cause of cancer mortality, and cigarette smoking is the most significant risk factor. Among smokers at high risk for lung cancer, atherosclerotic cardiovascular disease (ASCVD) also poses a significant risk for morbidity and mortality. Fortunately, there are opportunities of the prevention of ASCVD events during lung cancer screening (LCS). Observations: Chest low-dose computed tomography (LDCT) scans used for LCS provide information about the absence or severity of coronary artery calcification (CAC), another independent risk factor of ASCVD events. Of note, there are clinically important differences in using CAC scores to guide primary prevention and statin therapy in smokers eligible for LCS compared with those of the general population. This review article focuses on these differences. Conclusions: We provide recommendations on using CAC scores from LDCT to guide the prevention of ASCVD events in LCS in addition to using cardiac testing and when referral to a cardiovascular specialist should be considered.