Cardiovascular disease (CVD) is a leading cause of death in Australia² and contributes to a significant healthcare burden.³
The National Heart Foundation of Australia has published a position statement on coronary artery calcium scoring for the primary prevention of CVD.
The Heart Foundation recognises that the evidence for coronary artery calcium scoring to refine CVD risk assessment, and to guide subsequent management, is evolving. This position statement provides practical advice for health professionals on the use of coronary artery calcium scoring to assist in defining risk, in conjunction with CVD risk assessment⁴, for the primary prevention of CVD in Australia.
The position statement was developed by the National Heart Foundation of Australia and considers the evidence in the context of Australian practice. The position statement was written by members of an expert reference group, including a variety of leading topic experts and health professionals. A rigorous approach was used to develop this position statement and included consultation with multiple stakeholders and established methods to assess the certainty of the evidence. The Heart Foundation acknowledges that the limited availability of Australian published literature impacts on the certainty of the evidence. Therefore, this position statement provides conditional recommendations to guide health professionals on when a coronary artery calcium score may be useful to help determine a person’s risk of heart attack.
Further information about the development process can be found in the position statement.
To support health professionals, we have developed a clinical factsheet and algorithm from the National Heart Foundation of Australia: Position Statement on coronary artery calcium scoring for the primary prevention of cardiovascular disease in Australia.
This clinical factsheet provides a summary of the Heart Foundation’s position statement on coronary artery calcium scoring for the primary prevention of CVD in the Australian population and includes information about:
Coronary artery calcium scoring can have a role in reclassification of CVD risk for selected people in Australia. The position statement and algorithm outline the importance of using CVD risk assessment, in conjunction with coronary artery calcium scoring. Using a shared decision-making approach that considers a person’s preferences and values is essential.
This plain language summary of the Heart Foundation’s position statement on the use of coronary artery calcium scoring for the primary prevention of CVD can be used to facilitate a discussion with your patients. The summary has been developed to help people understand:
Heart attack and stroke are some of Australia’s biggest killers. The Heart Foundation works to prevent people from developing heart disease through awareness campaigns, resources and support programs.
Our guidance for health professionals includes the use of risk scores to help estimate a person’s risk of having a heart attack or stroke. As part of a Heart Health Check, your doctor can estimate your risk of heart attack or stroke based on any risk factors you may have. These can include raised blood pressure or high cholesterol. These factors are used to calculate a risk score, to estimate your risk of having a heart attack or stroke in the next five years. People can be classified as high, moderate, or low risk. Your doctor will make recommendations about changes to your health behaviours, such as stopping smoking. They may also prescribe medication to reduce the risk of a heart attack or stroke.
The Heart Foundation reviewed the evidence to assess whether coronary artery calcium scoring can help better understand a person’s risk of having a heart attack.
A coronary artery calcium score is a measure of how much calcified plaque (calcium) is in the walls of your heart’s arteries (blood vessels). A build-up of plaque can cause these arteries to become narrow, reducing the amount of blood, oxygen and nutrients that reach your heart. In some cases, this plaque can break away and form a clot that blocks the arteries, causing a heart attack. A coronary artery calcium score is measured using a non-invasive computed tomography (CT) scan of the heart. The CT scan shows how much calcium is in the walls of the heart’s blood vessels. The amount of calcium is reported on a number scale. A score of zero indicates there is no calcified plaque. Medical dye or contrast is not used in CT scans for measuring a coronary artery calcium score. In someone without previous symptoms or a diagnosis, coronary artery calcium scoring can indicate a person’s risk of heart attack.
Our position is that there can be a role for coronary artery calcium scoring in determining a person’s risk of heart attack. Our recommendations for the use of coronary artery calcium scoring are conditional. This means the recommendations are based on the best available evidence, but more research is needed to fully understand the role of coronary artery calcium scoring. The Heart Foundation acknowledges that Australian research on calcium scoring is limited. This affects the certainty of the evidence and our recommendations. We encourage people to speak to their doctor about their risk of heart attack and stroke. It is important to decide together whether a coronary artery calcium score is appropriate.
The decision to have a coronary artery calcium score will depend on many factors. Your doctor will discuss these with you, including:
Your risk factors
Cost
Your personal preferences and values
How useful coronary artery calcium scoring is will vary from person to person. Your doctor is best placed to help work out if calcium scoring will be useful for you. Our recommendations guide health professionals on:
When a coronary artery calcium score could be considered
How a coronary artery calcium score could be used to work out your risk of heart attack
Watch our webinar “Driving best practice CVD prevention in a post-COVID world”. Chaired by Prof Garry Jennings, our expert panel explore the latest evidence to support CVD risk assessment and management in primary care, including the latest on coronary artery calcium scoring.
1. Jennings GLR, Audehm R, Bishop W, et al. National Heart Foundation of Australia: position statement on coronary artery calcium scoring for the primary prevention of cardiovascular disease in Australia. Med J Aust. 2021;214(9):434-439.
2. Australian Bureau of Statistics. Causes of Death 2018 [Cat. No. 3303.0]. Canberra: ABS, 2019. Available from: https://www.abs.gov.au/ausstats/[email protected]/mf/3303.0
3. Australian Bureau of Statistics. National Health Survey: First results 2017 – 18 Australia [Cat. No. 4364.0.55.001]. Canberra: ABS, 2018. Available from: https://www.abs.gov.au/statistics/health/health-conditions-and-risks/national-health-survey-first-results/2017-18
4. National Vascular Disease Prevention Alliance. Guidelines for the management of absolute cardiovascular disease risk. National Stroke Foundation, 2012. Available from: http://www.cvdcheck.org.au/pdf/Absolute_CVD_Risk_Full_Guidelines.pdf
Last updated13 May 2021