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Cohort studyJournal of the American College of Cardiology · 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 study

Borderline ASCVD risk patients with CAC >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 et al. · Journal of the American College of Cardiology · 2026

Background

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

Purpose

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

Methods

Individuals from the MESA (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 CAC 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, CAC 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 ASCVD event rates remained elevated even when CAC was absent, suggesting that CAC 0 should not generally be used to withhold statin therapy in these individuals.

Post

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

Borderline ASCVD risk patients with CAC >0 had higher annual event rates.

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