The absence of coronary calcium: Clinical and therapeutic implications for the clinical lipidologist

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations


Background: Cardiac computed tomography for coronary artery calcium scoring, a diagnostic test associated with relatively low radiation exposure, provides incremental coronary risk stratification above that provided by Framingham risk scoring in asymptomatic, intermediate-risk patients. Knowledge of the appropriate use of coronary calcium scoring enables the clinician to more appropriately match the intensity of preventive cardiovascular care to the individual's absolute risk of coronary heart disease (CHD). Methods: A Medline search was used for original articles pertinent to coronary artery calcium scoring from 2000 to 2010. Results: Despite the presence of coronary risk factors, up to 45% of asymptomatic, presumed intermediate-risk patients referred for coronary calcium scoring have no detectable coronary calcium, a finding associated with a 1 to 2% 10-year risk of CHD death or nonfatal myocardial infarction. Such patients could logically be given a more prolonged opportunity to respond to therapeutic lifestyle change and, if necessary, generic lipid-altering medication before more expensive treatment strategies are implemented. Conclusions: Because coronary calcium scoring is usually a self-pay test, the test should be ordered only in those circumstances in which knowledge of the results will change coronary risk management. This review addresses these issues and attempts to place the clinical utility of this important diagnostic test in perspecitive for the clinician.

Original languageEnglish (US)
Pages (from-to)472-477
Number of pages6
JournalJournal of Clinical Lipidology
Issue number6
StatePublished - Nov 1 2010
Externally publishedYes


  • Coronary artery calcium scoring
  • Coronary calcium score zero
  • Coronary heart disease prevention
  • Hyperlipidemia treatment
  • Lipid management
  • Subclinical atherosclerosis detection and treatment

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Nutrition and Dietetics
  • Cardiology and Cardiovascular Medicine


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