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 measure(s) 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.