TITLE:
The Power and the Limits of Zero: Strengths and Pitfalls of CT Coronary Artery Calcium Score in Risk Assessment
AUTHORS:
Enoch Chi Ngai Lim, Chi Eung Danforn Lim
KEYWORDS:
Coronary Artery Calcium Score, Cardiovascular Risk Assessment, Agatston Score, Statins, Coronary Artery Atherosclerosis
JOURNAL NAME:
Journal of Biosciences and Medicines,
Vol.13 No.10,
October
20,
2025
ABSTRACT: Assessing cardiovascular risk by measuring coronary artery calcium (CAC) scoring obtained by computed tomography is well understood and is an accepted practice. It determines the amount of calcium in the atherosclerotic plaque present in the coronary arteries with significant accuracy and establishes the risk of suffering a future cardiac event. CAC scoring enhances the value of traditional risk factors, facilitating improved patient management. In this review, we examined a case with a CAC scoring result and analysed the case to see how it influenced the decision-making process. The case illustrates how decision-making is assisted by CAC scoring in comparison with other cardiac tests, particularly as a basis for initiating preventive therapies, such as statins. Although of such great importance, CAC also has some limitations. CAC cannot identify non-calcified plaque, and in some cases, it can be misleading. This narrative review, supplemented from a practical standpoint, suggests that CAC scanning is generally cost-effective in intermediate-risk groups because it avoids unnecessary lifelong statin therapy in low-risk individuals while targeting therapy to those with demonstrable atherosclerosis. However, considerations of radiation (approximately 1 mSv per scan) and potential downstream testing from incidental findings must be weighed. Most guidelines recommend. From a practical aspect, CAC scanning is generally cost-effective in intermediate-risk groups because it avoids unnecessary lifelong statin therapy in low-risk individuals while targeting therapy to those with demonstrable atherosclerosis. However, considerations of radiation (approximately 1 mSv per scan) and potential downstream testing from incidental findings must be weighed. Most guidelines recommend the selective use, rather than widespread population screening, of cardiovascular risk assessment to balance cost, benefit, and safety.