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Cited by 32Cardiac Imaging and DiagnosticsLipoproteins and Cardiovascular HealthCoronary Interventions and Diagnostics

Coronary Artery Calcium Staging to Guide Preventive Interventions

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Maron, David J., Budoff, Matthew J., Sky, Joseph C., Bommer, William J., Epstein, Sarah D., Fisher, Dane A., Stock, Eveline O., Taylor, Allen J. +2 more·2024·JACC: Advances
DOI 10.1016/j.jacadv.2024.101287PMC PMC11462328
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Abstract

C oronary artery calcium (CAC) as measured by the Agatston score is a strong predictor of atherosclerotic cardiovascular disease (ASCVD) events. 1 In the 2019 American College of Cardiology (ACC) and American Heart Association (AHA) clinical practice guideline for the primary prevention of cardiovascular disease, it is a Class IIa recommendation to use the CAC score to inform shared decision-making for individuals at intermediate risk if the decision to start statins is uncertain after global risk assessment and the consideration of risk enhancing factors. 2 The 2022 ACC Expert Consensus Decision Pathway on the role of nonstatin therapies for low-density lipoprotein cholesterol (LDL-C) lowering in the management of ASCVD risk recommended that CAC measurement be considered to inform treatment decisions for adults without clinical ASCVD when there is either clinician uncertainty or patient hesitancy about starting statin therapy.3 That document recommended LDL-C threshold levels for the consideration of different intensities of statin and nonstatin therapy depending on the CAC score among borderline and intermediate risk individuals.Budoff and colleagues reported subsequently that the risk for major adverse cardiovascular events of individuals without clinical ASCVD with a CAC score >300 is equivalent to the risk of individuals with a documented history of myocardial infarction, stroke, or peripheral arterial disease (ie, ASCVD), 4 suggesting that such patients could be treated similarly to those with clinical ASCVD.Despite overwhelming evidence that CAC is a powerful predictor of ASCVD events and the aforementioned recommendations of medical societies, clinicians remain uncertain how to manage patients once they document the presence and quantity of CAC.A widely practiced, personalized approach to managing disease throughout medicine is to stage the disease.The rationale for staging is to determine the extent, severity, location, and prognosis of disease, and use this to tailor the type and intensity of therapy.Staging also provides a common language with which clinicians can communicate with each other and with patients.This approach has been adopted by the American Cancer Society.The AHA and ACC have developed a staging system to inform the management of heart failure.5 More recently, the AHA developed a staging system for cardiovascularkidney-metabolic syndrome.One of the criteria defining Stage 3 in that construct is presence of

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  • AI-CAC models that generate Agatston scores and guideline-aligned CAC categories integrate naturally with existing ASCVD prevention frameworks, supporting threshold-based decisions regarding statin prescription or intensification.

    “AI-CAC models that generate Agatston scores and guideline-aligned CAC categories integrate naturally with existing ASCVD prevention frameworks, supporting threshold-based decisions regarding statin prescription or intensification.53”

    From Prognostication and clinical opportunities with AI for coronary artery calcium: a scoping review (2026) · cites this paper as [53]

    In “Coronary Artery Calcium Staging to Guide Preventive Interventions” (page not provided), the proposed staging table links CAC score ranges to statin recommendations based on ACC/AHA guidance. The paper does not address AI-CAC models or establish that their outputs integrate with these frameworks; that part of the claim is an inference beyond the source. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

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Authors
Maron, D. J., Budoff, M. J., Sky, J. C., Bommer, W. J., Epstein, S. D., Fisher, D. A., Stock, E. O., Taylor, A. J., Wong, N. D., & DeMaria, A. N.
Affiliations
  • Stanford Medicine (US)
  • University of California, Los Angeles (US)
  • David Grant USAF Medical Center (US)
  • University of California, Davis (US)
  • University of California, Berkeley (US)
  • University of California, San Francisco (US)
  • MedStar Washington Hospital Center (US)
  • University of California, Irvine (US)
  • University of California San Diego (US)
Corresponding author
Maron, David J.
ORCID
Venue
JACC: Advances
Publisher
Elsevier BV
Published
2024-11
Volume
3
Issue
11
Pages
101287
ISSN
2772-963X (ISSN-L)
DOI
10.1016/j.jacadv.2024.101287
PMC
PMC11462328
OpenAlex
W4402766182
Cited by
32
References
12
Citations by year
2026: 17 · 2025: 14 · 2024: 1
Type
journal article
Language
en
Open access
Licence
Locations
  • JACC Advances (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
  • Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
  • Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
Keywords
coronary artery calcium, Agatston score, atherosclerotic cardiovascular disease, primary prevention, statin therapy, LDL cholesterol lowering, disease staging, intermediate cardiovascular risk, shared decision-making, cardiovascular risk assessment

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