Real-world impact of coronary artery calcium scoring on primary prevention management in a community cardiology practice.

STUDY

OBJECTIVE

To evaluate the impact of coronary artery calcium (CAC) scoring on lipid-lowering therapy intensification, aspirin initiation, and downstream cardiac testing in primary prevention patients in a community cardiology setting.

DESIGN

Retrospective observational study.

SETTING

Single community cardiology practice.

PARTICIPANTS

Four hundred consecutive patients undergoing CAC scoring in 2022.

INTERVENTIONS: CAC scoring used for risk stratification and clinical decision-making.

MAIN OUTCOME MEASURES: Changes in lipid-lowering therapy, aspirin initiation, and downstream cardiac testing across CAC categories (0, 1-99, 100-399, ≥400); risk reclassification using Pooled Cohort Equations (PCE) and Multi-Ethnic Study of Atherosclerosis (MESA) risk scores.

RESULTS

Among 400 patients (mean age 60.2 ± 10.6 years; 46.5% male), 30% had CAC = 0, 37% CAC 1-99, 18% CAC 100-399, and 16% CAC ≥400. Lipid therapy modification increased across categories (7.7%, 33.3%, 69.0%, 81.7%; p < 0.001), as did aspirin initiation among aspirin-naive patients (1.0%, 8.0%, 51.9%, 52.5%; p < 0.001) and stress testing (2.7%, 6.5%, 29.0%, 68.6%; p < 0.001). Each one-category CAC increment was independently associated with lipid therapy modification (adjusted OR 4.36, 95% CI 3.13-6.06), aspirin initiation (OR 4.48, 95% CI 2.85-7.03), and stress testing (OR 5.11, 95% CI 3.33-7.84; all p < 0.001). CAC changed MESA risk category in 192/348 patients (55.2%): 87 upward and 105 downward.

CONCLUSIONS

CAC burden was independently associated with graded intensification of lipid-lowering therapy, aspirin initiation, and downstream testing after multivariable adjustment, extending prior descriptive literature with persistent, quantified associations in real-world community practice. Improvement in clinical outcomes cannot be assessed from this retrospective, six-month implementation study.