Prevention & lipidsCohort study
Development and Validation of a Coronary Artery Calcium Volume and Density Score
- prospective cohort study
- external validation in 4 longitudinal cohorts
Authors' conclusion
The CAC volume and density score, which adjusts CAC volume downward for higher density, and can be calculated from existing CAC reports, significantly improves risk discrimination and reclassification compared with the Agatston score.
Study context
- Population
- MESA (Multi-Ethnic Study of Atherosclerosis) participants with coronary artery calcium (CAC)>0 and follow-up for coronary heart disease (CHD) eventsMESA cohort
- Participants
- 3,360 participants
- Exposure
- Score performance for CHD risk prediction was compared with the pooled cohort equations and the Agatston score
Main finding
As reported in the abstract
C -index for CHD when added to the pooled cohort equation
CAC volume and density score
0.699
C -index · 95% CI 0.675–0.723
Agatston score
0.687
C -index · 95% CI 0.663–0.711
Observational data: associations, not effects.
Further findings
Continuous net reclassification improvement
| Outcome | CAC volume and density score | Agatston score | pooled cohort equations |
|---|---|---|---|
| Continuous net reclassification improvement when added to the pooled cohort equation | 0.54 (95% CI 0.43–0.64) | 0.45 (95% CI 0.34–0.56) | Not reported in the abstract |
Risk prediction improvement by CAC burden
- The greatest improvement in risk prediction was in those with lower burden of CAC (Agatston <300)
Stratified analyses and external validation
- Consistent results were seen in stratified analyses and external validation cohorts
Original publication
Development and Validation of a Coronary Artery Calcium Volume and Density Score. Circ Cardiovasc Imaging. Published 12 October 2026. doi:10.1161/circimaging.126.020112
Summarised from the published abstract; every number is checked against it