Calcium scans may tip the balance for borderline heart-risk patients

Analyses of the Multi-Ethnic Study of Atherosclerosis followed more than 6,000 participants for a decade, comparing the PREVENT risk calculator with coronary artery calcium (CAC) scores. While CAC added only a modest statistical boost overall, it significantly refined risk classification for those labeled borderline (3-5%) or intermediate (5-10%) by PREVENT, helping identify who would later experience heart attacks or strokes.

Experts caution that CAC should not replace statin therapy, especially when the score is zero, but can serve as a useful tiebreaker in ambiguous cases. The research aligns with recent ACC-AHA guideline updates that endorse using incidental calcium findings for men over 40 and women over 45 at uncertain risk. Costs for dedicated CAC scans range from $100 to $400 and are often not covered, though opportunistic CT scans performed for other reasons can provide comparable information. Clinicians are advised to discuss risk assessment and treatment options with patients as early as age 30.