There are no good studies directly answering this question. However, most studies that have looked at statin use in patients with elevated coronary calcium scores have found that many of those patients are also on aspirin 81 mg daily. My own practice is that I would certainly use a statin in patient...

Agree. Certainly, statins have the strongest evidence in patients with elevated coronary calcium and evidence of CAD. It is a more nuanced decision regarding low dose as the benefit is less than a statin and needs to counterbalance the risk of bleeding. Certainly, in younger patients with very eleva...

Any amount of CAC is suggestive of CAD. If you send a patient with chest pains to cardiac cath: he/she has 30-50% plaques and you assume that the chest pains are non-cardiac; you are still going to treat that patient with ASA+ statin+ BP Rx etc. So I see no difference between #1 and #2. Therefor...

I agree.

I do not use the calcium score alone. I try to examine all of the risk factors and come up with overall assessment of risk. There are multiple cardiovascular risk calculators out there. So someone with a greater than 10% risk of cardiac event in the next 10 years, probably I would start the baby asp...

I would look at known contributors to calcification i.e. Lp(a). If elevated, although generally, the guidelines suggest no treatment, there are studies now finding a reduction in MACE events with PCSK-9 inhibitors. More long-term studies are needed to see the effect on calcium mass in both the coron...