Recommendations for asymptomatic individuals based on their coronary calcium sore can be summarized as follows.
-Calcium scores of 0 identify individuals in the "lowest-risk" group with 10 year risk for cardiac events less than 5%. These individuals are to be reassured and CAC scans should be repeated no more often than every 5 years.
-Calcium scores between 1 and 80 also identify "low-risk" individuals. Consequently; these individuals can be recommended to undergo risk factor modification alone and the CAC scans may be repeated at two to five year intervals to monitor for progression.
-Calcium scores from 81 to 400 identify individuals at increased risk for cardiac events and many of these individuals will be re-stratified to the "intermediate-risk" or "high-risk groups". These individuals should be treated according to the secondary prevention guidelines of the American Heart Association with reduction of the LDL cholesterol to less than 100 mg% as specified in the NCEP ATP III guidelines. These individuals should also undergo repeat scans every one to two years to monitor treatment response.
-Calcium scores above 400 identifies individuals in the "high-risk" group and these individuals also have a high likelihood (>90%) of having at least one significantly obstructed coronary vessel (>70% stenosis). The risk for the development of symptomatic cardiac disease in these patients may be as high as 4.8% per year and additional evaluation for the presence of at risk myocardium should be done in addition following the secondary heart disease prevention guidelines of the American Heart Association. Repeat CAC scans are recommended annually to monitor disease progression and treatment response.
-Individuals with super-high CAC scores, CAC scores > 1000, have an annual cardiac event rates in the range of 18% to 24%. These individuals should have urgent cardiology referral for testing for inducible ischemia and be treated very aggressively to lower the risk for cardiac events.
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