What is the guideline recommendation regarding CAC scoring?

• A. Useful for down-classifying ASCVD risk in those with a 10-year risk of 7.5% or higher when risk is uncertain
• B. Useful only for confirming ASCVD in high-risk patients
• C. Not recommended for any risk assessment
• D. Used to diagnose diabetes

Answer: (A)

Coronary artery calcium scoring is a tool for refining ASCVD risk in adults with intermediate 10-year risk. The point is that a zero CAC score can reclassify someone to a lower risk category, potentially avoiding statin therapy, while a higher CAC score indicates greater risk and supports more aggressive prevention. This makes it useful for down-classifying ASCVD risk in people with a 10-year risk around 7.5% or higher when the risk estimate is uncertain.

It isn’t a diagnostic test for diabetes, nor a test to confirm ASCVD in high-risk patients, and it isn’t used for all-risk assessment—its value is in refining risk in those with intermediate risk to guide treatment decisions.