Ann Cardiol Cardiovasc Med | Volume 8, Issue 1 | Research Article | Open Access

Reclassification of Cardiovascular Risk Using Coronary Artery Calcium Scoring in a Preventive Cardiology Clinic Population

Mustaqeem M*, Naseer A, Araib E, Hassan K and Hanif B

1Department of Cardiology, Tabba Heart Institute, Karachi, Pakistan 2Department of Acute Medicine, Princess Alexander Hospital, UK

*Correspondance to: Marium Mustaqeem 

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Introduction: South Asians have the highest rates of premature ASCVD globally, a phenomenon not entirely explained by traditional risk factors. Effective risk assessment is crucial for primary prevention, guiding treatment strategies. US prevention guidelines advocate for pooled cohort equations for risk estimation, promoting shared decision-making. Coronary Artery Calcium (CAC) score, a specific marker of plaque burden, independently predicts CHD, stroke, and ASCVD events, even in low-risk individuals. This study assesses how incorporating calcium scoring affects patient risk classification compared to ASCVD risk scoring alone. Material and Methods: A total of 204 consecutive asymptomatic subjects, who underwent comprehensive screening in a primary prevention clinic were included. Standard risk factors participants were evaluated by specialized primary care providers, underwent a comprehensive assessment encompassing detailed history, physical examination, and laboratory evaluation. Routine Coronary Artery Calcium Scoring (CACS) was a standard part of this evaluation. 10-year risk ASCVD was calculated using baseline data according to the Pooled Cohort Equations, then categorized as low (<5%), intermediate (5 to 19.9%), and high risk (≥ 20%) group. CAC score was categorized as 0 and >0. Result: Mean Age, BMI, total cholesterol, ASCVD score, Calcium score were, 52 ± 9, 28.9 ± 5.3, 178 ± 45, 10.4 ± 10.8 and 176 ± 490 respectively. In ASCVD risk assessment, 79 individuals were categorized as low-risk (<5%), 90 as intermediate risk (5–19.9%), and 35 as high risk (≥ 20%). Concurrently, based on their CAC score, 108 individuals had a normal score (0), while 96 had an abnormal score (>0). When CAC risk categorization were applied, notable shifts would occur in ASCVD risk categories. 42 subjects would move from the 2nd to the 1st category, and 29 from the 3rd to the 2nd. Additionally, 6 individuals (3%) would experience a 2-category downgrade, while 19 (9%) would undergo a 1-category upgrade. In total, 47% of subjects could see their ASCVD risk category change if CAC risk categorization were implemented. Conclusion: In a primary prevention screening program of asymptomatic patients, addition of CACS results in significant risk reclassification emphasizing the importance of CACS for more accurate and impactful risk evaluation and prevention of CHD.


Mustaqeem M, Naseer A, Araib E, Hassan K, Hanif B. Reclassification of Cardiovascular Risk Using Coronary Artery Calcium Scoring in a Preventive Cardiology Clinic Population. Ann Cardiol Cardiovasc Med. 2024; 7(1): 1054..

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