Study Finds Calcium Scans Best as a Tiebreaker for Borderline Heart‑Risk Patients
A JAMA analysis shows coronary artery calcium scores most often change treatment decisions for people with borderline or intermediate PREVENT risk, supporting targeted rather than routine scanning.
Overview
- The JAMA paper published Aug. 26, 2026 analyzed about 6,098 MESA participants aged 45–79 followed for 10 years and found 366 atherosclerotic cardiovascular disease events.
- Across the whole cohort adding coronary artery calcium (CAC) to the PREVENT equations improved model discrimination only slightly from 0.73 to 0.75, indicating modest overall benefit.
- For people with PREVENT-classified borderline risk the 10-year event rates rose sharply across CAC categories from 1.9% with CAC=0 to 14.3% with CAC≥300, showing the test better separates low from high outcome risk in this group.
- CAC produced meaningful reclassification within the borderline/intermediate subgroup, moving 50% of future cases into higher-risk categories and 61% of noncases into lower-risk categories, which can alter decisions about starting or deferring statin therapy.
- Authors and commentators say the results align with 2026 ACC/AHA guidance to use CAC selectively and note evidence gaps for younger adults and specific high-risk ethnic groups as well as practical trade-offs of cost and radiation exposure.