Table 2.
Recommendation for the use of the CAC score in asymptomatic patients.
| Low risk | Low risk + family | ||||
|---|---|---|---|---|---|
| Authority guidelines | Low risk | + DM | history* of early CAD | Intermediate risk | High risk |
| 2010 ACCF/SCCT/ACR(21) | Inappropriate | - | Appropriate | Appropriate | Uncertain |
| 2014 ACR(22) | Typically inappropriate | - | Can be appropriate | Appropriate | Typically inappropriate |
| 2010 ACCF/AHA(23) | IIb | - | - | IIa | - |
| 2012 ESC(24) | - | - | - | IIa | - |
| 2014 II Diretriz da SBC/CBR(18) | III | IIa | IIa | I | III |
| 2013 ACC/AHA(25) | IIb: If, after risk assessment, the treatment based on the decision is uncertain, evaluation with the CAC score can be | ||||
| considered in order to define the most appropriate therapeutic strategy† | |||||
DM, diabetes mellitus; CAD, coronary artery disease; ACCF, American College of Cardiology Foundation; SCCT, Society of Cardiovascular Computed Tomography; ACR, American College of Radiology; AHA, American Heart Association; ESC, European Society of Cardiology; SBC, Sociedade Brasileira de Cardiologia (Brazilian Society of Cardiology); CBR, Colégio Brasileiro de Radiologia (Brazilian College of Radiology and Diagnostic Imaging).
Classes of recommendation: Class I - Conditions for which there is conclusive evidence or, in the absence thereof, general agreement that the procedure is safe and useful/effective; Class II - Conditions for which there is conflicting evidence and/or divergence of opinion on safety, and utility/effectiveness of the procedure; Class IIa - Weight of divergences in favor of the use/effectiveness of the method. Most approve; Class IIb - Safety and utility/effectiveness less well established, with no predominance of opinions in favor. Class III - Conditions in which there is evidence, general agreement or both, that the procedure is not useful and effective, and in some conditions may even be harmful.
First-degree male relative < 55 years of age or first-degree female relative < 65 years of age.
After discussing with the patient, when the decision to initiate statin therapy is difficult to make in selected individuals who are not in one of the four groups benefiting from the use of statin, defined as described: atherosclerotic cardiovascular disease (ACD); primary elevation of low-density lipoprotein cholesterol (LDL C) ≥ 190 mg/dL; 40-75 years of age with diabetes and an LDL-C of 70- 189 mg/dL; and 40-75 years of age without ACD or diabetes, with an LDL-C of 70-189 mg/dL and a ≥ 7.5% estimated 10-year risk of ACD.