Opportunistic Detection of Coronary Artery Calcium on Noncardiac Chest Computed Tomography: An Emerging Tool for Cardiovascular Disease Prevention: A Scientific Statement From the American Heart Association
Open accessAbstract
Coronary artery calcium (CAC) is a marker of subclinical atherosclerosis that confers increased risk of atherosclerotic cardiovascular disease. Measured by noncontrast cardiac computed tomography, CAC improves risk stratification beyond traditional risk factors and can aid decision-making for allocation of preventive treatments. Although national guidelines recommend consideration of CAC measurement for >17 million individuals in the United States with borderline to intermediate 10-year atherosclerotic cardiovascular disease risk, adoption has been limited. A promising approach to bridge this gap is opportunistic detection of CAC using non-ECG-gated chest computed tomography scans that are performed for a noncardiac indication. Approximately 19 million non-ECG-gated chest computed tomography scans are performed per year, and reporting opportunistic detection of CAC from these scans can enhance atherosclerotic cardiovascular disease risk stratification without additional radiation exposure, cost, or burden. Estimation of risk by traditional risk factor scoring is underused, and reporting of opportunistic detection of CAC has the potential to alert physicians of risk, independent of guideline-recommended risk calculator use. Advancements in artificial intelligence allow integration of automated CAC quantification into clinical practice. Several artificial intelligence algorithms are in use to improve the likelihood of reporting opportunistic detection of CAC and appropriate allocation of preventive therapies. Systematic approaches are needed to ensure appropriate reporting, interpretation, and action while avoiding unnecessary downstream testing. Implementation that includes tailored preventive care and streamlined care pathways involving multidisciplinary clinical teams including radiology, cardiology, and primary care is essential.
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Clinical use of CAC scoring remains low due to limited clinician awareness, inconsistent insurance coverage, and concerns regarding radiation exposure and incidental findings.
“Despite strong evidence and clear recommendations, clinical use of CAC scoring remains low due to limited clinician awareness, inconsistent insurance coverage, and concerns regarding radiation exposure and incidental findings.5”
From Prognostication and clinical opportunities with AI for coronary artery calcium: a scoping review (2026) · cites this paper as [5]
Evaluating existing non-cardiac chest CT scans for CAC could expand preventive cardiology by leveraging nearly 19 million non-cardiac chest CTs performed annually in the USA, compared with roughly 1 million dedicated CAC scans.
“Evaluating these existing scans for CAC, termed opportunistic CAC detection, could expand preventive cardiology by leveraging nearly 19 million non-cardiac chest CTs performed annually in the USA, compared with roughly 1 million dedicated CAC scans.5”
From Prognostication and clinical opportunities with AI for coronary artery calcium: a scoping review (2026) · cites this paper as [5]
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Self-citation
- Authors
- Foraker, R., Sperling, L., Bratzke, L., Budoff, M., Leppert, M., Razavi, A. C., Rodriguez, F., Shapiro, M. D., Whelton, S., Wong, N. D., Yang, E., & on behalf of the American Heart Association Prevention Science Committee of the Council on Epidemiology and Prevention and Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; and Council on Cardiovascular Radiology and Intervention
- ORCID
- Venue
- Circulation
- Published
- 2025-11-11
- Volume
- 152
- Issue
- 19
- Pages
- e391-e401
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- PMC
- PMC13034728
- OpenAlex
- W4415265522
- Cited by
- 44
- References
- 63
- Citations by year
- 2026: 41 · 2025: 3
- FWCI
- 6.94
- Type
- journal article
- Language
- en
- Open access
- Locations
- Circulation (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Heart, Lung, and Blood Institute (R01HL169345)
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
- Keywords
- coronary artery calcium, atherosclerotic cardiovascular disease, subclinical atherosclerosis, cardiovascular risk stratification, artificial intelligence, risk calculator, multidisciplinary care pathway
- MeSH terms
- Computed Tomography Angiography, American Heart Association, Cardiovascular Diseases, Coronary Artery Disease, Coronary Vessels, Humans, Risk Factors, Tomography, X-Ray Computed, United States, Risk Assessment, Vascular Calcification
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