December 2023
Putting coronary artery calcium on computed tomography into context

Among people without cardiovascular disease, CT-detectable CAC increased markedly with age in every demographic group.

Coronary artery calcium (CAC), noted as an incidental finding on chest computed tomography (CT) performed for other reasons, is increasingly reported, but should it engender more medication use, cardiology referrals and stress testing as has been reported? Investigators sought to place incidentally noted coronary calcification in context by determining CAC prevalence by age, sex, race and ethnicity among individuals who were enrolled in the Multi-Ethnic Study of Atherosclerosis (MESA) study. MESA involved about 6800 people (age range, 45 to 84 years; mean age, 62 years) who were free from clinical atherosclerotic cardiovascular disease at enrolment approximately 20 years ago (Circulation 2006; 113: 30-37).

The prevalence of detectable CAC increased markedly with age in every demographic group. Men had a higher prevalence than women in each age-range category. Non-Hispanic white men, in whom CAC prevalence exceeded 50% by age 50 to 54 years, tended to have the highest prevalence.

Comment: Although the MESA study is not fully representative of the US population, these data suggest that CAC on CT is common, particularly in non-Hispanic white men, and its prevalence rises substantially with age. In part because of the high prevalence with increasing age, the authors suggest that seeing CAC incidentally on chest CT done for other reasons should not lead reflexively to aspirin or statin treatment or to specialist referral. Rather, they advocate for comprehensive atherosclerotic cardiovascular disease risk assessment and discussion of patient preferences, an approach with which I agree. Editorialists note that randomised, controlled trials showing improved outcomes with CAC-based strategies are lacking, but they cite two ongoing trials that should give us more answers (ROBINSCA [Eur Heart J Cardiovasc Imaging 2020; 21: 1216-1224] and CorCal).

Kirsten E. Fleischmann, MD, MPH, FACC, Professor of Clinical Medicine, Division of Cardiology, University of California San Francisco School of Medicine; Medical Director, Cardiac Stress Laboratory, UCSF Medical Center, San Francisco, USA.

Tattersall MC, et al. Incidental coronary artery calcium on chest CT in persons without known atherosclerotic cardio- vascular disease. JAMA Intern Med 2023 Sep 25; e-pub (

Garg PK, Brown DL. Coronary artery calcium screening – data first. JAMA Intern Med 2023; 183: 1270-1271.

This summary is taken from the following Journal Watch titles: General Medicine, Cardiology, Ambulatory Medicine, Hospital Medicine.

JAMA Intern Med