Prevention & lipidsCohort study
The Role of Coronary Artery Calcium in Statin Eligibility Based on the American Heart Association’s PREVENT Calculator
- Prospective cohort study
- multiethnic cohort (MESA)
Authors' conclusion
In this large multiethnic cohort, CAC provided its greatest clinical value when statin treatment decisions were uncertain, particularly among individuals with borderline predicted risk. Among participants who already met guideline-based treatment thresholds, observed ASCVD event rates remained elevated even when CAC was absent, suggesting that CAC 0 should not generally be used to withhold statin therapy in these individuals.
Study context
- Population
- MESA participants; risk categories in those with LDL-C 70 to 189 mg/dL without DM
- Participants
- 5,698 participants
- Exposure
- Coronary artery calcium (CAC) 0 vs CAC >0 across statin eligibility groups and 10-year PREVENT-ASCVD risk categories
- Not recommendedn = 1,924
- Consideredn = 897
- Recommendedn = 2,877
- Outcome
- CV event (atherosclerotic cardiovascular disease (ASCVD)) incidence rates per 1,000 person-years across CAC strata
Main finding
As reported in the abstract
ASCVD event rate per 1,000 person-years by statin eligibility, CAC 0
- CAC >0: not recommended, considered, recommended (per 1,000 person-years)
- 4.5, 5.2, 16.6
Observational data: associations, not effects.
Further findings
| Outcome | <3% | 3% to <5% | 5% to <10% | ≥10% |
|---|---|---|---|---|
| Event rate per 1,000 person-years, CAC 0 vs CAC >0, by 10-year PREVENT-ASCVD risk (LDL-C 70–189 mg/dL, no DM) | ||||
| CAC 0 | 1.1 | 2.7 | 5.9 | 6.2 |
| CAC >0 | 3.0 | 5.2 | 11.3 | 20.9 |
Original publication
The Role of Coronary Artery Calcium in Statin Eligibility Based on the American Heart Association’s PREVENT Calculator. J Am Coll Cardiol. Published 15 July 2026. doi:10.1016/j.jacc.2026.05.039
Summarised from the published abstract; every number is checked against it