Coronary Calcium and Assessing Risk in the PREVENT Era

In the 2026 American College of Cardiology/American Heart Association cholesterol guideline, the PREVENT risk calculator replaces equations previously used to estimate atherosclerotic cardiovascular disease (ASCVD) risk. Coronary artery calcium (CAC) scores can further aid risk assessment; however, data on their added value largely come from studies using those earlier equations (Figure 1).

To update these data, investigators used a cohort of ~5700 people enrolled in the Multi-Ethnic Study of Atherosclerosis, evaluating ASCVD event rates across 10-year PREVENT risk categories of low (<3%), borderline (3–<5%), intermediate (5–<10%), and high (≥10%), and then stratifying by CAC.