Coronary Calcium Score vs. Computed Tomography Angiography as Tools to Stratify Cardiovascular Risk

Purpose of Review: This review evaluates the evidence for and against the use of coronary artery calcium (CAC) score and coronary computed tomography angiography (CTA) on the cardiovascular risk stratification for primary prevention in asymptomatic individuals. Recent Findings: Recent evidence suggests that the presence and extent of CAC are robust predictors of events across various populations and variable baseline risk. On the other hand, the absence of CAC is associated with a good prognosis event in older individuals or in those with multiple risk factor or high clinical risk. While coronary CTA is also useful for risk stratification, its results did not provide incremental discrimination of individuals once the CAC is accounted for. Thus, current evidence does not support its use in asymptomatic individuals. Summary: CAC is a powerful tool for additional cardiovascular risk stratification in individuals where the need for pharmacological therapy for risk reduction in primary prevention is uncertain, such as in individuals with intermediate risk. Since coronary CTA does not further improve risk stratification in this population, it is not currently recommended in asymptomatic individuals. © 2018, Springer Science+Business Media, LLC, part of Springer Nature.