Coronary calcium scoring for guiding lipid‐lowering therapy is cost‐effective: time to remove barriers to its use

Erfan Tasdighi and Michael J Blaha
Med J Aust 2023; 218 (5): . || doi: 10.5694/mja2.51861
Published online: 20 March 2023

Widespread, inexpensive CAC scanning could economically expand access to statin therapy to those at highest risk

Coronary artery calcium (CAC) scores, in combination with traditional cardiovascular disease (CVD) risk factors, can help identify who would obtain the most and who the least benefit from statin treatment.1 However, there are drawbacks to routinely incorporating CAC scores into CVD risk assessment, including the direct medical cost ($US50–250 per scan in the United States) and indirect costs (time required for CAC scanning, incidentaloma detection, subsequent rescanning) for patients and the health care system.

  • Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, United States of America



Erfan Tasdighi has received support from National Institutes of Health (grant T32 HL007227).

Competing interests:

No relevant disclosures.

  • 13. Al‐Kindi SG, Costa M, Tashtish N, et al. No‐charge coronary artery calcium screening for cardiovascular risk assessment. J Am Coll Cardiol 2020; 76: 1259‐1262.
  • 1. Blaha MJ, Budoff MJ, DeFilippis AP, et al. Associations between C‐reactive protein, coronary artery calcium, and cardiovascular events: implications for the JUPITER population from MESA, a population‐based cohort study. Lancet 2011; 378: 684‐692.
  • 2. Venkataraman P, Neil AL, Mitchell GK, et al. The cost‐effectiveness of coronary calcium score‐guided statin therapy initiation for Australians with family histories of premature coronary artery disease. Med J Aust 2023; 218: 216‐222.
  • 3. Venkataraman P, Kawakami H, Huynh Q, et al. Cost‐effectiveness of coronary artery calcium scoring in people with a family history of coronary disease. JACC Cardiovasc Imaging 2021; 14: 1206‐1217.
  • 4. Hong JC, Blankstein R, Shaw LJ, et al. Implications of coronary artery calcium testing for treatment decisions among statin candidates according to the ACC/AHA cholesterol management guidelines: a cost‐effectiveness analysis. JACC Cardiovasc Imaging 2017; 10: 938‐952.
  • 5. Pletcher MJ, Pignone M, Earnshaw S, et al. Using the coronary artery calcium score to guide statin therapy: a cost‐effectiveness analysis. Circ Cardiovasc Qual Outcomes 2014; 7: 276‐284.
  • 6. van Kempen BJH, Ferket BS, Steyerberg EW, et al. Comparing the cost‐effectiveness of four novel risk markers for screening asymptomatic individuals to prevent cardiovascular disease (CVD) in the US population. Int J Cardiol 2016; 203: 422‐431.
  • 7. van Kempen BJH, Spronk S, Koller MT, et al. Comparative effectiveness and cost‐effectiveness of computed tomography screening for coronary artery calcium in asymptomatic individuals. J Am Coll Cardiol 2011; 58: 1690‐1701.
  • 8. Roberts ET, Horne A, Martin SS, et al. Cost‐effectiveness of coronary artery calcium testing for coronary heart and cardiovascular disease risk prediction to guide statin allocation: the Multi‐Ethnic Study of Atherosclerosis (MESA). PLoS One 2015; 10: e0116377.
  • 9. Galper BZ, Wang YC, Einstein AJ. Strategies for primary prevention of coronary heart disease based on risk stratification by the ACC/AHA lipid guidelines, ATP III guidelines, coronary calcium scoring, and C‐reactive protein, and a global treat‐all strategy: a comparative–effectiveness modeling study. PLoS One 2015; 10: e0138092.
  • 10. Sniderman AD, Thanassoulis G, Lawler PR, et al. Comparison of coronary calcium screening versus broad statin therapy for patients at intermediate cardiovascular risk. Am J Cardiol 2012; 110: 530‐533.
  • 11. Khan SS, Navar AM. The potential and pitfalls of coronary artery calcium scoring. JAMA Cardiol 2022; 7: 11‐12.
  • 12. Søgaard R, Diederichsen ACP, Rasmussen LM, et al. Cost effectiveness of population screening vs. no screening for cardiovascular disease: the Danish cardiovascular screening trial (DANCAVAS). Eur Heart J 2022; 43: 4392‐4402.


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