Ten reasons to treat all individuals with a positive coronary artery calcium score.

Coronary artery disease has reached epidemic proportions in the United States and remains the number one cause of death of both adult men and women. This review focuses on the importance of treating all positive coronary artery calcium (CAC) scores with aggressive anti-atherogenic therapy. The reasons for this approach include: 1) atherosclerosis is a preventable, fatal disease, 2) CAC scores increase with time, 3) the response to statin therapy improves with shorter duration of exposure to atherogenic cholesterol, 4) myocardial infarctions occur at all CAC scores, 5) myocardial infarctions cause great family stress, and 6) CAC testing and treatment are cost effective. A positive CAC score almost always represents cholesterol plaques in the coronary arteries which have been increasing for many months. Treatment with rosuvastatin and ezetimibe has been shown to be effective at reducing and preventing cardiovascular disease with minimal adverse effects. Reducing the incidence of myocardial infarctions in the United States (600,000 per year) requires aggressive prevention of all atherosclerotic disease in the coronary arteries and should not be delayed.