Top Things to Know: Opportunistic Detection of Coronary Artery Calcium on Non-Cardiac Chest Computed Tomography
Published: October 16, 2025
Prepared by Sally Wong, PhD, RD, CDN – National Sr. Director, Science and Medicine
- Coronary artery calcium (CAC) is a marker of subclinical atherosclerosis and is strongly linked to an increased risk of atherosclerotic cardiovascular disease (ASCVD) events.
- When measured via non-contrast cardiac computed tomography, CAC improves risk stratification beyond traditional risk factors and can aid in decision-making for allocation of preventive treatments.
- Opportunistic detection of CAC (ODCAC), which is easily detected on non-ECG-gated chest computed tomography (CT) scans performed for medical reasons other than to measure CAC, has the potential to bridge this gap and alert physicians of patient risk, independent of guideline-recommended risk calculator use.
- Approximately 19 million noncardiac chest CT scans are performed annually in the US, considerably more than the 1 million dedicated CAC scans per year. Therefore, quantification and reporting of ODCAC represents a significant opportunity to improve ASCVD risk stratification and appropriate allocation of preventive medication among a much larger and more diverse population of patients.
- Upon identification of incidental CAC, clinicians should consider engage in a risk discussion with patients regarding the significance and prognostic implications of such findings.
- The detection of CAC is increasingly recognized as a valuable factor in assessing ASCVD risk and informing treatment decisions.
- The pragmatic detection of CAC through opportunistic use of chest CT, particularly when enhanced by AI technology, holds the potential to favorably impact ASCVD risk assessment and management.
- For AI-based CAC detection to reach its full potential, ongoing research and validation will be necessary to establish accuracy, reliability, and integration within clinical workflows.
- Studies to assess the clinical utility of AI-derived CAC scores in various populations will further inform best practices, including thresholds for treatment initiation or modification.
- This scientific statement highlights that systematic approaches are needed to ensure appropriate reporting, interpretation, and action, while avoiding unnecessary downstream testing. Implementation that includes tailored preventive care and streamlined care pathways involving multidisciplinary clinical teams including radiology, cardiology, and primary care is essential.
Citation
Foraker R, Sperling L, Bratzke L, Budoff M, Leppert M, Razavi AC, Rodriguez F, Shapiro MD, Whelton S, Wong ND, Yang E; on behalf of the American Heart Association Prevention Science Committee of the Council on Epidemiology and Prevention and Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; and Council on Cardiovascular Radiology and Intervention. Opportunistic detection of coronary artery calcium on noncardiac chest computed tomography: an emerging tool for cardiovascular disease prevention: a scientific statement from the American Heart Association. Circulation. Published online October 16, 2025. doi: 10.1161/CIR.0000000000001382