CAC score may help regulate statins in patients with borderline ASCVD risk

USA: CAC score should be used in patients with borderline or intermediate ASCVD risk to assist in the decision of taking or withdrawing statin use for primary prevention of ASCVD, suggests a recent study in the journal Mayo Clinic Proceedings.

The decision about whether to recommend a statin for the primary prevention of atherosclerotic cardiovascular disease (ASCVD) although is clear in patients with high ASCVD score, but whether to allot statins or not in patients with borderline or intermediate-risk has been a conundrum. Patient-specific treatment decisions are needed to provide maximal benefit and avoid unnecessary treatment. 

Guideline-based lipid management proposes that coronary artery calcium (CAC) scoring is reasonable to implement in patients with a 10-year risk of 5.0% to 19.9% (borderline to intermediate risk) by using the pooled cohort equations when the decision about whether to initiate statin therapy is uncertain

Carl E. Orringer and Kevin C. Maki from the USA reported data from both observational studies and a large primary prevention randomized controlled trial that support the position that this decision is, in fact, uncertain in about half of such patients because of risk misclassification.