7
Table
3.
Proposed
Decision-Making
Approach
to
Selective
Use
of
CAC
Measurement
for
Risk
Prediction
Using
10-year
ASCVD
Risk
Estimate
plus
CAC
Score
to
Guide
Statin
Therapy
Patient's
10-year
ASCVD
risk
estimate
<5%
5%–7.4%
7.5%–19.9%
≥20%
Consulting
ASCVD
risk
estimate
alone
Statin
not
recommended
Consider
statin
Recommend
statin
Recommend
statin
Consulting
ASCVD
risk
estimate
+
CAC
If
CAC
score
=
0
Statin
not
recommended
Statin
generally
not
recommended
Statin
generally
not
recommended
Recommend
statin
If
CAC
score
>0
Statin
may
be
considered
Recommend
statin
Recommend
statin
Recommend
statin
Does
CAC
score
modify
treatment
plan?
× CAC
less
effective
for
this
population
✔ CAC
can
reclassify
risk
up
or
down
✔ CAC
can
reclassify
risk
up
or
down
× CAC
not
effective
for
this
population
Note:
CAC
=
0
should
not
be
used
as
sole
justification
for
use
of
lifestyle
alone,
to
the
exclusion
of
pharmacotherapy
in
familial
hyper-cholesterolemia,
advanced
diabetes,
and/or
active
smoking.
Source:
From
Greenland
P,
Blaha
MJ,
Budoff
MJ,
Erbel
R,
Watson
KE.
"Coronary
Calcium
Score
and
CV
Risk."
J
Am
Coll
Cardiol.
2018;
72(4):
434-447.
