The Role of Coronary Artery Calcium in Statin Eligibility Based on the American Heart Association's PREVENT…

Cohort studyJournal of the American College of Cardiology· Jul 2026

The Role of Coronary Artery Calcium in Statin Eligibility Based on the American Heart Association's PREVENT Calculator: Insights From MESA.

Rishi Rikhi, Haiying Chen, Saeid Mirzai … Michael D Shapiro

CardiologyCohort studyTreatmentQ1IF 9.1

Borderline ASCVD risk patients with coronary artery calcium >0 had higher annual event rates.

The Role of Coronary Artery Calcium in Statin Eligibility Based on the American Heart Association's PREVENT Calculator: Insights From MESA.

Rishi Rikhi … Michael D Shapiro

Journal of the American College of Cardiology · Jul 2026

Background

The 2026 American College of Cardiology/American Heart Association/multisociety dyslipidemia guideline incorporates the PREVENT atherosclerotic cardiovascular disease (atherosclerotic cardiovascular disease) equations for estimation of 10-year atherosclerotic cardiovascular disease risk, replacing the Pooled Cohort Equations used in previous prevention guidelines.

Purpose

In this study, the authors sought to evaluate cardiovascular event rates across calcium strata within statin eligibility groups and 10-year PREVENT risk categories.

Methods

Individuals from the Multi-Ethnic Study of Atherosclerosis (Multi-Ethnic Study of Atherosclerosis) were included.

n = 5,698 participants

Results

higher annual heart attack or stroke rate for borderline risk people with calcium

CAC 0, Risk <3%

1.1per 1,

CAC >0, Risk <3%

3per 1,

CAC 0, Risk 3-<5%

2.7per 1,

CAC >0, Risk 3-<5%

5.2per 1,

More results

Among the 5,698 participants included in this analysis, the mean age was 61.5 ± 10.3 years and 52.8% were female.

Statin therapy was not recommended in 1,924 participants (33.8%), considered in 897 participants (15.7%), and recommended in 2,877 participants (50.5%).

More results

The event rates per 1,000 person-years in those without calcium in the not recommended, considered, and recommended statin groups were 1.2, 2.7, and 5.8, respectively.

“

Conclusion · 1 of 2

In this large multiethnic cohort, calcium provided its greatest clinical value when statin treatment decisions were uncertain, particularly among individuals with borderline predicted risk.

Conclusion · 2 of 2

Among participants who already met guideline-based treatment thresholds, observed atherosclerotic cardiovascular disease event rates remained elevated even when calcium was absent, suggesting that calcium 0 should not generally be used to withhold statin therapy in these individuals.

The Role of Coronary Artery Calcium in Statin Eligibility Based on the American Heart Association's PREVENT Calculator: Insights From MESA.

The Role of Coronary Artery Calcium in Statin Eligibility Based on the American Heart Association's PREVENT Calculator: Insights From MESA.

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