Impact of coronary artery calcium scores on cardiovascular risk and preventive therapies: A systematic review and meta-analysis

Abstract

Introduction: Coronary artery calcium (CAC) scoring is a key noninvasive method for detecting subclinical atherosclerosis and refining cardiovascular risk assessment. It enhances traditional risk models and plays an expanding role in preventive cardiology. This systematic review and meta-analysis aimed to evaluate the relationship between CAC presence and cardiovascular outcomes, as well as its impact on the initiation and continuation of preventive pharmacologic and lifestyle interventions among asymptomatic and symptomatic individuals without known coronary artery disease (CAD).

Methods: Following PRISMA guidelines, a systematic search was conducted through February 2025 across PubMed, Scopus, Google Scholar, Cochrane Central, and ClinicalTrials.gov. Eligible studies included randomized controlled trials and observational research comparing outcomes and behaviors between individuals with a CAC score of zero and those with a score above zero.

Results: Fifty-three observational studies involving 210,672 asymptomatic and 32,477 symptomatic participants were analyzed. Over an average follow-up of 8.6 years, the presence of CAC was significantly associated with increased risks of major adverse cardiovascular events (OR: 5.58), all-cause mortality (OR: 3.90), myocardial infarction (OR: 4.01), and revascularization (OR: 11.90). CAC presence also correlated with greater odds of initiating and continuing preventive therapies such as aspirin, lipid-lowering, and blood pressure medications, as well as adopting healthier lifestyle changes like increased physical activity and improved diet.

Conclusion: CAC is a robust, independent marker of future cardiovascular risk and a strong catalyst for clinical intervention. Its use in risk stratification can enhance personalized prevention strategies in both asymptomatic and symptomatic populations.