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Abstract
The 2018 ACC (American College of Cardiology)/AHA (American Heart Association) and 2021 ESC (European Society of Cardiology)/EAS (European Atherosclerosis Society) guidelines recommend coronary artery calcium (CAC) score for risk refinement in primary prevention of atherosclerotic cardiovascular disease (ASCVD). This study sought to compare CAC utility as a risk-refining tool following the ACC/AHA guideline using pooled cohort equations (PCE) or PREVENT (Predicting Risk of cardiovascular disease EVENTs) equations and ESC/EAS guideline using SCORE2 (Systematic COronary Risk Evaluation 2). A total of 1,903 statin-naive participants 55 to 75 years of age, free of ASCVD and diabetes, with low-density lipoprotein cholesterol<190mg/dL from the prospective population-based Rotterdam Study were included. Per the guidelines, we determined proportions of CAC scan-eligible and reclassified men and women, ASCVD incidence rates, and numbers needed to treat for 10 years (NNT10y). By the ACC/AHA (PCE), 18.3% of men and 11.9% of women, and by ACC/AHA (PREVENT), 13.4% of men and 3.4% of women were eligible for a CAC scan. By the ESC/EAS, 46.6% of men and 44.9% of women were CAC eligible. Proportions of uprisked and derisked individuals varied per guideline. Among ACC/AHA and ESC/EAS CAC-eligible individuals, incidence rates ranged from 9.3 to 23.8 per 1,000 person-years, and the estimated NNT10y to prevent 1ASCVD event, based on high-intensity statin use, varied from 11 to26. The ACC/AHA and ESC/EAS guidelines differ in the selection and application of the CAC score for primary prevention of ASCVD. Guideline-directed application of CAC score in a middle-aged apparently healthy population improved risk stratification at an acceptable NNT10y for both guidelines.
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