Taking off from last Friday's post, where Micheal Budoff has an excellent review of the paper discussed, comes the need to discuss the role of coronary artery calcium measurements.
As Budoff points out, there is enough data now to show that a calcium score of 0 is associated with a very low risk of a possible future cardiac event. This is something that we have seen anecdotally as well. In this setting, the additional yield of looking for soft plaques in a screening population, for picking up coronary artery disease, is very low.
In an individual patient, this may still be justified, especially if the patient has intermediate to high risk. This is why despite a calcium score of 0, we still go ahead and perform an angiogram. When we see soft plaques, there is a further stratification that can be then performed based on the LDL levels and the patient can be advised accordingly. However, from a mass screening perspective, it may be very dificult to justify looking for soft plaques, especially with all the associated issues of radiation and contrast injection.