Written by Babatunde Carew
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In patients at intermediate risk of atherosclerotic cardiovascular disease (ASCVD) with a family history of premature coronary artery disease (CAD), a coronary artery calcium (CAC) score-informed prevention strategy led to slower coronary plaque progression.
CAC scoring steers CV prevention
A CAC score is a quick, noninvasive, CT-based tool that can refine ASCVD risk assessment in asymptomatic intermediate-risk individuals to help guide decisions on statin therapy. AHA guidelines support this practice, but there are limited data to suggest that treatment decisions guided by CAC scores lead to improved clinical outcomes.
This study, the CAUGHT-CAD trial, evaluated whether CAC-score-informed treatment reduced plaque progression in 365 statin-naive, intermediate-risk Australian adults with a family history of premature CAD (first degree relative < 60 or second degree relative < 50). Over three years, those receiving CAC-guided therapy (starting statin therapy for CAC score > 0) had less progression in total plaque volume (15.4 vs 24.9 mm³; P = .009) compared to the usual care group on baseline vs. repeat coronary CTA (cCTA) at 3 years. Limitations include small sample size, use of an Australian risk stratification tool (narrowing the generalizability of results), relatively short follow-up period, and use of plaque progression rather than major adverse coronary events as the primary outcome.
How does this change my practice?
This study reinforces my current practice of obtaining CAC scores in patients at intermediate ASCVD risk to help guide statin decisions, but further studies are needed to examine how plaque progression relates to clinical outcomes in this group. Beyond its role in risk assessment, I’ve found that visualizing plaque with a CAC score improves patient buy-in to cardiac risk reduction pharmacotherapy and lifestyle measures. It is important to note that CAC scoring may underestimate cardiac risk, as it does not detect non-calcified plaque.
Source
Effects of Combining Coronary Calcium Score With Treatment on Plaque Progression in Familial Coronary Artery Disease: A Randomized Clinical Trial. JAMA. 2025 Apr 22;333(16):1403-1412. doi: 10.1001/jama.2025.0584. PMID: 40042839
