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Published on: August 28, 2018
Coronary Artery Calcium in ACC/AHA Prevention Guidelines: Evolution From 2007 to 2026
Kyvan Irannejad1, Ruben Mora1, Srikanth Krishnan1
1Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, USA.
Abstract:
Coronary artery calcium (CAC) scoring is an established marker of subclinical atherosclerosis that improves cardiovascular risk stratification beyond traditional risk factors. Since the 2007 ACCF (American College of Cardiology Foundation)/AHA (American Heart Association) Clinical Expert Consensus Statement, the role of CAC in prevention guidelines has progressively evolved. The strength of CAC recommendations has increased from a Class IIb recommendation for selected intermediate-risk adults in 2007 to a Class IIa recommendation for risk refinement in the 2018 ACC/AHA cholesterol guideline and to Class I recommendations for selected CAC-defined populations in the 2026 ACC (American College of Cardiology)/AHA multisociety dyslipidemia guideline. The 2018 guideline incorporated CAC primarily to guide statin allocation when treatment decisions were uncertain. The 2026 guideline further expands CAC-based recommendations by incorporating age- and sex-adjusted percentiles, CAC-guided treatment intensity, and low-density lipoprotein-cholesterol goals, including management of very high CAC phenotypes. In this brief report, the authors review the evolution of CAC across the 2007, 2018, and 2026 ACC/AHA guideline documents and discuss the expanding role of CAC in personalized cardiovascular prevention.
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