Table 2.

Role of coronary calcium in primary prevention guidelines

Guideline	Clinical score for risk assessment	Target group	Evaluation of CAC	Class of recommendation/ level of evidence
2017 SCCT Expert Consensus: Clinical Indications for Coronary Artery Calcium Scoring in Asymptomatic Patients35	PCE (10-year risk of ASCVD)	Asymptomatic individuals (40–75 years old) without clinical ASCVD in the 5–20% 10-year ASCVD risk group or selected adults in the <5% ASCVD group (i.e. those with a family history of premature coronary artery disease)	Is reasonable	Not provided
2018 ACC/AHA Guideline Management of blood cholesterol32	PCE (10-year risk of ASCVD)	Asymptomatic individuals (40–75 years old) at intermediate risk (≥7.5% to <20% 10-year ASCVD risk) without diabetes and with LDL-C levels ≥70–189 mg dL−1 or selected adults at borderline risk (5% to <7.5% 10-year ASCVD risk)	Is reasonable	Class IIa LoE: B
2019 ACC/AHA Guideline: Primary Prevention of Cardiovascular Disease31	PCE (10-year risk of ASCVD)	Adults at intermediate risk (≥7.5% to <20% 10-year ASCVD risk) or selected adults at borderline risk (5% to <7.5% 10-year ASCVD risk), if risk-based decisions for preventive interventions remain uncertain	Is reasonable	Class IIa LoE: B
2021 ESC Guidelines: Cardiovascular Disease Prevention in Clinical Practice34	SCORE2 and SCORE-OP (10-year risk of CVD)	Individuals with calculated risks around treatment decision thresholds	May be considered	Class IIb LoE: B

ACC/AHA, American College of Cardiology/American Heart Association; ASCVD, atherosclerotic cardiovascular disease; CVD, cardiovascular disease; ESC, European Society of Cardiology; LDL, low-density lipoprotein; LoE, level of evidence; PCE, pool cohort risk equations; SCCT, Society of Cardiovascular Computed Tomography; SCORE2, systematic coronary risk estimation 2; SCORE2-OP, systematic coronary risk estimation 2—older person.