Peter Attia MD - Using the coronary calcium (CAC) score to predict cardiovascular disease risk | Allan Sniderman
The coronary artery calcium (CAC) score is a cardiovascular imaging tool that uses x-ray techniques to detect calcium deposits in the coronary arteries, which are indicative of advanced atherosclerosis. The presence of coronary calcification is strongly associated with an increased risk of heart attack or stroke. However, the utility of the CAC score varies with age. For individuals over 60, a positive CAC score is common and may not provide additional risk information, as age itself is a significant risk factor. Conversely, a zero CAC score in older individuals can be reassuring, suggesting other protective factors at play despite high apolipoprotein B (apoB) levels. For younger individuals, a positive CAC score is a significant concern, indicating early cardiovascular disease and necessitating intervention regardless of apoB levels. The discussion highlights the importance of considering long-term risk and the limitations of relying solely on CAC scores for clinical decisions, especially when other risk factors like high apoB are present.
Key Points:
- CAC score detects coronary artery calcification, indicating advanced atherosclerosis and higher cardiovascular risk.
- Positive CAC scores are more common and less informative in individuals over 60 due to age-related risk.
- A zero CAC score in older adults can be reassuring, but high apoB levels still require attention.
- In younger individuals, a positive CAC score is a significant risk indicator, necessitating early intervention.
- CAC scores should not be the sole factor in clinical decisions; consider long-term risk and other factors like apoB.