Arq. Bras. Cardiol. 2023; 120(10): e20230708

The “Coming of Age” of Coronary Calcium Score?

António Miguel Ferreira , Rita Lima , Nuno Bettencourt

DOI: 10.36660/abc.20230708

This Short Editorial is referred by the Research article "Determination of Vascular Age in Men Using the Coronary Calcium Score and its Impact on Restratification of Cardiovascular Risk".

The use of coronary artery calcium (CAC) score to guide the primary prevention of atherosclerosis and its manifestations has grown in popularity in recent years. Its advantages over the current paradigm of risk-factor-based calculators include better discrimination and greater predictive power, with the promise of better treatment decisions and timely implementation of personalized preventive measures.^–

CAC results are usually expressed as an absolute value and as a percentile among individuals of the same age and sex. Importantly, conveying this information to patients seems to improve their adherence to lifestyle modifications and pharmacological therapy. One of the ways developed for making patients understand their risk is the concept of vascular age. Quite simply, an individual’s vascular age assessed by CAC score is the average age at which people of the same sex have a similar degree of coronary calcification. So, if a person’s vascular age is higher than their chronological age, this indicates a higher risk of cardiovascular events than one would suppose. For instance, a 50-year-old female smoker with a vascular age of 70 may realize that she needs to take preventive measures to reduce her risk. Conversely, when vascular age is lower than chronological age, it suggests a lower risk compared to their age group. Although vascular age provides a clear and relatable way to communicate cardiovascular risk to patients, it should be noted that it might convey the false notion that atherosclerosis is part of the natural aging process. It is not. Nevertheless, despite this imprecision, its clinical usefulness remains.

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