Coronary Calcium Scoring for Subclinical Atherosclerosis Detection in Asymptomatic Middle-Aged Adults: Risk Reclassification, Treatment Decisions, and One-Year Statin Initiation Patterns

Coronary artery calcium score (CACS), measured by non-contrast cardiac CT, provides a direct measure of subclinical atherosclerosis with strong prognostic value beyond conventional cardiovascular risk equations. We assessed the impact of CACS testing on risk reclassification and statin initiation in 380 asymptomatic middle-aged adults (198 men, 182 women) referred from primary care for cardiovascular risk assessment. Most participants (152, 40.0%) had a CACS of zero, while 70 (18.4%) had a score above 300. Compared with the conventional pooled-cohort ASCVD risk equation alone, the addition of CACS reclassified 41.6% of participants 23.2% downward to a lower treatment-decision category and 18.4% upward. Statin initiation among intermediate-risk participants rose from 42% before CACS testing to 68% after, while statin de-escalation occurred in 47 patients (12.4%) with CACS of zero who had previously been on therapy. CACS testing meaningfully reshaped treatment decisions in a real-world preventive cardiology population and supports its incorporation into shared decision-making for primary prevention.