Coronary Artery Calcium Helps Identify Patients Eligible for Statins

In 2014, the American College of Cardiology and American Heart Association released guidelines encouraging statin use among adults at increased risk for heart disease. Based on these guidelines, adults with at least a 5% risk of developing heart disease in the next ten years should at least consider cholesterol-lowering statins to reduce cardiovascular risk. Currently, more than 45 million middle-aged adults would qualify for statins based on their risk. However, experts worry that recommendations are too broad, as statin use is most appropriate in patients with truly high cardiovascular risk.

To help refine guidelines, researchers studied the impact of coronary artery calcium on cardiovascular risk. Coronary artery calcium (or CAC) is the build-up of calcium in the walls of the coronary arteries. CAC is measured using a non-invasive CT scans and can help assess an individual’s risk for heart disease. Research suggests that not only can CAC increase risk for heart attack, but that the more CAC a person has, the greater their risk for developing heart disease.  

To learn more about the impact of CAC on cardiovascular risk, researchers analyzed data from the Multiethnic Study of Atherosclerosis and published their findings in the Journal of the American College of Cardiology. Often referred to as MESA, this study included more than 4,700 U.S. adults free of heart disease that did not take cholesterol-lowering medication. Participants were followed for up to ten years, tracking key health outcomes like heart attack and death. (View the risk calculator used in this study.)

Based on the most recent guidelines, researchers found that 50% of all participants were eligible for statins due to increased risk for heart disease. However, roughly half of eligible candidates had no coronary artery calcium, which puts them at a lower risk for heart disease.

Based on findings, authors believe that CAC may be a useful tool for identifying patients truly in need of statins. (One important caveat: Since CAC is not yet recommended as a routine part of screening or risk assessment, insurance currently doesn't cover the cost of CAC scoring.) Patients that benefit the most from statins are those at greatest risk for heart disease, like those with calcium build-up in addition to traditional risk factors.  While current guidelines recommend statins for all adults at increased risk for heart disease, CAC may help further refine which adults should be on the medication.