October 2022
Calcium scoring to refine cardiovascular risk prediction?

A meta-analysis suggests improvement in discrimination is modest.

Coronary artery calcium (CAC) scores can be used to refine cardiovascular (CV) risk prediction, but is the incremental benefit sufficient to use CAC scores in primary prevention? In this meta-analysis, investigators identified six studies that reported the incremental value of CAC scores in CV risk prediction over CV risk determined by using calculators recommended in national guidelines alone. Studies varied in size (470 to 5185 participants), mean patient age (50 to 75 years) and percentage of women enrolled (38 to 59%).

Overall, CAC scores increased ability to identify CV risk. Participants deemed to be low risk by CV risk calculators but who were reclassified as intermediate- to-high risk after CAC scoring had a 4 to 14% chance of experiencing adverse CV events during follow up, which ranged from five to 10 years. Conversely, of those deemed to be intermediate-to-high risk by CV risk calculators but low risk after CAC scoring 1 to 9% experienced adverse CV events during follow up.

Comment: In this meta-analysis, the authors found that CAC scoring added modestly to traditional clinical risk scores for CV disease prediction. However, editorialists point out the disadvantages of testing, including a small dose of radiation, cost (including the cost of downstream testing) and risk for unanticipated incidental findings. They call for outcomes studies that could help us assess the trade-offs involved and to understand whether, and for whom, calcium scoring would improve cardiovascular outcomes.
Professor of Clinical Medicine, University of California San Francisco School of Medicine; Medical Director, Cardiac Stress Laboratory, UCSF Medical Center, San Francisco, USA.

Bell KJL, et al. Evaluation of the incremental value of a coronary artery calcium score beyond traditional cardiovascular risk assessment: a systematic review and meta-analysis. JAMA Intern Med 2022; 182: 634-642.
Gallo RJ, Brown DL. Addition of coronary artery calcium scores to primary prevention risk estimation models – primum non nocere. JAMA Intern Med 2022; 182: 590-591.

This summary is taken from the following Journal Watch title: General Medicine.

JAMA Intern Med 2022