How should we use the coronary artery calcium score to predict cardiovascular risk?

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The coronary artery calcium (CAC) score--an independent predictor of cardiovascular events (strength of recommendation [SOR]: C, systematic review of disease-oriented outcomes)--can be used, in addition to traditional risk factor assessment, to further stratify the risk of coronary heart disease (CHD) in asymptomatic patients (SOR: C, multiple large observational studies with disease-oriented outcomes). Although a high CAC score is associated with a greater risk of cardiovascular disease, no studies have evaluated cardiovascular outcomes of CAC-guided treatment, so its value remains theoretical.

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