Coronary Artery Calcium-Based Approach to Lipid Management

Purpose of Review We review the clinical utility and incorporation of coronary artery calcium (CAC) in traditional cardiovascular risk assessments to guide lipid management, specifically in the appropriate allocation of lipid-lowering therapies. We intentionally exclude discussion of non-pharmacolog...

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Bibliographic Details
Published in:Current cardiovascular risk reports 2022-12, Vol.16 (12), p.181-194
Main Authors: Kole, Ayeeshik, Joshi, Parag H.
Format: Article
Language:English
Subjects:
Asymptomatic
Atherosclerosis
Calcification
Cardiology
Cardiovascular disease
Cholesterol
Clinical medicine
Cohort analysis
Coronary vessels
Decision making
Diabetes
Disease prevention
Family medical history
Heart
Lipids
Lipids (M. Shapiro
Medicine
Medicine & Public Health
Population
Risk assessment
Risk factors
Section Editor
Statins
Tomography
Topical Collection on Lipids
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Summary:Purpose of Review We review the clinical utility and incorporation of coronary artery calcium (CAC) in traditional cardiovascular risk assessments to guide lipid management, specifically in the appropriate allocation of lipid-lowering therapies. We intentionally exclude discussion of non-pharmacologic lifestyle interventions, statin safety and its associated side effects, radiation safety, and the value of care with the use of CAC, as well as other nuances in lipid management that are beyond the scope of this review. Recent Findings CAC-based cardiovascular risk assessment and statin allocation are endorsed by clinical practice guidelines. New research supports the additional value of CAC in guiding intensification, allocation, and re-allocation of statin and non-statin lipid-lowering therapies, such as PCSK9 inhibitors and icosapent ethyl. Further, emerging evidence demonstrates the potential impact of CAC for further risk stratification when abnormal levels of non-traditional components of the lipid profile such as apolipoprotein B and lipoprotein(a) are identified. Summary CAC scoring has value for the management of lipid-lowering therapies, as it can aid shared decision-making regarding escalation or de-escalation of statin and non-statin therapies. With a CAC-based approach to lipid management, clinicians can personalize therapy to each particular patient, delivering intensive care to high-risk individuals who would benefit most while deferring treatment in low-risk patients who derive less benefit.
ISSN:1932-9520
1932-9563
DOI:10.1007/s12170-022-00704-z