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The approach to LDL-C management in primary prevention has shifted from lipid-centric strategies to personalized, risk-based frameworks. However, the binary distinction between primary and secondary prevention may overlook individuals with advanced subclinical atherosclerosis. Coronary artery calcium (CAC) scoring has become central in identifying such patients, especially those whose risk exceeds that implied by traditional risk calculators. The 2022 ACC Expert Consensus Decision Pathway (ECDP) incorporated CAC into LDL-C goal-setting, advocating for LDL-C 100 or >75th percentile. Emerging evidence suggests that CAC ≥300 portends risk comparable to clinical ASCVD, warranting even lower targets (300 as equivalent to secondary prevention.
Burka et al. (Thu,) studied this question.