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Selected examples of candidates for coronary artery calcium (CAC) measurement who might benefit from knowing their CAC score is zero[1]

Selected examples of candidates for coronary artery calcium (CAC) measurement who might benefit from knowing their CAC score is zero[1]
  • Patients reluctant to initiate statin therapy 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 to 80 years of age; women, 60 to 80 years of age) with low burden of risk factors who question whether they would benefit from statin therapy
  • Middle-aged adults (40 to 55 years of age) with PCE-calculated 10-year risk of ASCVD 5 to <7.5% with factors that increase their ASCVD risk, although they are in a borderline risk group
Caveats: If patient is intermediate risk and if a risk decision is uncertain and a CAC score is performed, 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 CAC score in 5 to 10 years. Moreover, if CAC is recommended, it should be performed in facilities that have current technology that delivers the lowest radiation possible.
PCE: pooled cohort equations; ASCVD: atherosclerotic cardiovascular disease.
Reference:
  1. Grundy SM, Stone NJ, Bailey AL, etc. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol. J Am Coll Cardiol 2019; 73:e285.
Original table modified for this publication. From: Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol; 74:e177. Table used with the permission of Elsevier Inc. All rights reserved.
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