TABLE 6.

Selected Examples of Candidates for Coronary Artery Calcium Measurement Who Might Benefit From Knowing Their Coronary Artery Calcium Score Is Zero

Coronary Artery Calcium Measurement Candidates Who Might Benefit from Knowing Their Coronary Artery Calcium Score Is Zero

Patients reluctant to initiate statin who wish to understand their risk and potential for benefit more precisely Patients concerned about need to reinstitute statin therapy after discontinuation for statin-associated symptoms Older patients (men 55–80 y of age; women 60–80 y of age) with low burden of risk factors (S4.4-42) who question whether they would benefit from statin therapy Middle-aged adults (40–55 y of age) with PCE-calculated 10-year risk for ASCVD 5% to <7.5% with factors that increase their ASCVD risk, although they are in a borderline risk group.

Caveats: If patient is at intermediate risk and if a risk decision is uncertain and a coronary artery calcium score is obtained, it is reasonable to withhold statin therapy unless higher-risk conditions, such as cigarette smoking, family history of premature ASCVD, or diabetes mellitus, are present and to reassess the coronary artery calcium score in 5 to 10 years. Moreover, if coronary artery calcium is recommended, it should be performed in facilities that have current technology and expertise to deliver the lowest radiation possible.

ASCVD indicates atherosclerotic cardiovascular disease; LDL-C, low-density lipoprotein cholesterol; and PCE, pooled cohort equations.

Reproduced with permission from Grundy et al. (S4.3-1). Copyright © 2018, American Heart Association, Inc., and American College of Cardiology Foundation.