Table 1.

Different indications in the evaluation of CACS for the assessment of cardiovascular risk between different guidelines

Guideline	Indication	Class of recommendation	Level of evidence
US Preventive Services Task Force (reference #26)	No indication	NA	NA
2018 Cholesterol Clinical Practice Guidelines (reference #24)	In intermediate-risk (≥7.5% to <20% 10-year ASCVD risk) adults or selected borderline-risk (5% to <7.5% 10-year ASCVD risk) adults in whom a coronary artery calcium score is measured for the purpose of making a treatment decision, AND  If the coronary artery calcium score is zero, it is reasonable to withhold statin therapy and reassess in 5–10 years, as long as higher-risk conditions are absent (e.g., diabetes, family history of premature CHD, cigarette smoking);  If coronary artery calcium score is 1 to 99, it is reasonable to initiate statin therapy for patients ≥55 years of age;  If coronary artery calcium score is 100 or higher or in the 75th percentile or higher, it is reasonable to initiate statin therapy	IIa	B
2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease (reference # [23])	In 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 (e.g., statin therapy) remain uncertain, it is reasonable to measure a coronary artery calcium score to guide clinician–patient risk discussion	IIa	B
2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes (reference # [22])	Assessment of coronary artery calcium score with computed tomography may be considered as a risk modifier in the cardiovascular risk assessment of asymptomatic subjects	IIb	B
Kaiser Permanente Atherosclerotic Cardiovascular Disease (ASCVD) Primary Prevention Guideline 2020 (reference # [25])	CACS: consider for patients at indeterminate risk or at intermediate risk and undecided about statins  CACS: although not routinely recommended, may be helpful for patients at intermediate ASCVD risk who are uncertain about taking a statin, and/or patients whose calculated risk is higher or lower than expected	NA	NA
2021 European Society of Cardiology (ESC) Guidelines on cardiovascular disease prevention in clinical practice (reference # [39])	CAC scoring may be considered to improve risk classification around treatment decision thresholds	IIb	B

ASCVD Atherosclerotic Cardiovascular Disease, CACS coronary artery calcium score, CAC coronary artery calcium, N.A. not available