Matthew J. Budoff, MD, FACC, Jennifer M. Malpeso, MD
Abstract. New recommendations put forth in the American College of Cardiology Foundation/ American Heart Association (ACC/AHA) Guidelines for Assessment of Cardiovascular Risk in Asymptomatic Adults and the updated 2010 Appropriate Use Criteria for Cardiac Computed Tomog¬raphy both reflect the unparalleled prognostic power of CAC scoring and it's unique ability to further refine current risk prediction models. The ACCF/AHA guidelines maintain the measurement of CAC is reasonable for cardiovascular risk assessment in asymptomatic adults at intermediate risk (10%-20% 10-year-risk) (IIa, Level of Evidence: B), low-to-intermediate risk (6%-10% 10-year-risk) (lib, Level of Evidence: B), and in diabetics over age 40 (IIa, Level of Evidence: B). There now exists a large body of published evidence depicting the independent and incremental prognostic value of CAC scoring over Framingham risk score-based strategy alone, a feature unmatched by any other biomarker under inves-tigation. Early detection of subclinical atherosclerosis through noninvasive assessment of CAC leads to more accurate risk stratification and a substantially higher net reclassification improvement (NRI) among intermediate-risk groups, deeming many patients newly eligible for lipid-lowering therapy and other preventative measures. © 2011 Society of Cardiovascular Computed Tomography. All rights reserved.