What is the recommendation for the use of coronary artery calcium (CAC) screening?
The Work Group recommends against the routine use of additional risk markers, such as coronary artery calcium (CAC) screening, for the prediction of future atherosclerotic cardiovascular disease endpoints in asymptomatic adults. Prospective studies of CAC screening do show improvement in the net reclassification index, but the use of CAC screening may result in overtreatment and unnecessary radiation exposure. No significant benefit in the incidence of myocardial infarction, cardiovascular disease, or overall mortality has been demonstrated with the addition of CAC scoring to a traditional risk score. The risk of radiation exposure from CAC scoring is not negligible, and the Work Group encourages a patient-provider conversation regarding the risk of over-diagnosis, cost, and radiation exposure in relation to a very small potential net benefit associated with CAC testing. The Work Group recommends prospective studies designed to assess the benefit of adding CAC to traditional risk scoring systems for the prediction of future atherosclerotic CVD endpoints.