MedCentralCoronary Artery Calcium Testing Should Be Used Selectively, New Study Says

This 2025 review updates clinical guidance on coronary artery calcium (CAC) testing, which is increasingly used to evaluate atherosclerotic cardiovascular disease risk and guide treatment decisions. The team’s findings, published in JAMA Cardiology and headed up by Alexander Zheutlin, MD, at Northwestern University’s Feinberg School of Medicine, identify specific patient populations for whom the test provides optimal clinical utility and those for whom it may yield limited value.

⚕️Key Clinical Considerations⚕️

• CAC testing in males younger than 40 years and females younger than 50 years with no risk factors may provide false reassurance about long-term atherosclerotic cardiovascular disease (ASCVD) risk.
• Limited clinical value exists for CAC testing in patients over 80 years and those already on statin therapy, as results offer minimal additional decision-making support.
• Repeated imaging after statin initiation provides no additional benefit because CAC scores do not predict plaque composition in these patients as they would for statin-naive individuals.
• Dr. Zheutlin emphasizes that optimal use occurs at “decision-making branch points” for intermediate-risk patients, despite the test being increasingly available and marketed to the public.
• Dr. Maros Ferencik notes that CAC scoring detects actual disease presence rather than just providing another risk factor, potentially improving patient adherence to recommended interventions.

🎯 Clinical Practice Impact 🎯

• Patient Communication: CAC scoring can serve as an effective motivational tool for reluctant patients, potentially improving adherence to lifestyle modifications and medication recommendations when disease is visualized.
• Practice Integration: Despite Dr. Matthew Budoff’s assertion that the test is “grossly underused” and could benefit 30-40% of adults (those at intermediate risk), practitioners should exercise clinical judgment in patient selection.
• Risk Management: Treatment intensity should be calibrated based on CAC score magnitude, with higher scores warranting more aggressive intervention as supported by published guidance.
• Action Items: Implement shared decision-making both before ordering CAC testing and after receiving results to optimize clinical value and patient engagement.

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