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Reply : Statins for primary prevention : problems with cardiovascular-risk estimation?

Concerning the prognostic value of CAC in asymptomatic low-risk individuals, it has been shown that CAC assessment may be useful in intermediate- or moderate-risk (but not low-risk) individuals in whom the required intensity of risk factors modification, including statin treatment, is often uncertain. In this category, a high CAC score could maybe identify patients at high risk, in whom intensive treatment of risk factors, including dyslipidemia, may be warranted while absence of relevant coronary calcification reclassifies these subjects to low risk but the percentage of moderate-risk subjects that would be so reclassified remains unknown. Therefore the European guidelines on CVD prevention recommend that CAC should be considered for CVD risk assessment only in moderate-risk subjects, and even this only with class IIa, level of evidence B and quality of evidence according to GRADE – weak.

statins; primary prevention; cardiovascular-risk estimation

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