{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T15:26:55Z","timestamp":1792855615842,"version":"4.5.0"},"reference-count":25,"publisher":"American Medical Association (AMA)","issue":"13","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2026,10,6]]},"abstract":"\n Importance<\/jats:title>\n The 2026 American College of Cardiology\/American Heart Association\/Multisociety Dyslipidemia Guideline newly recommends selective use of coronary artery calcium (CAC) scoring based on a 10-year risk of 3% to less than 10% estimated with the Predicting Risk of Cardiovascular Disease EVENTS (PREVENT) atherosclerotic cardiovascular disease (ASCVD) equations. However, the utility of CAC scoring alongside the PREVENT equations for ASCVD risk estimation is not known.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To determine the change in predictive utility when adding CAC scores to the PREVENT-ASCVD equations.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n Longitudinal observational cohort study conducted at 6 sites in the United States and enrolling adult participants aged 45 to 79 years without ASCVD at baseline in the Multi-Ethnic Study of Atherosclerosis.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Ten-year ASCVD risk with the PREVENT-ASCVD equations before and after adding CAC scores.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes<\/jats:title>\n Performance metrics for estimation of risk of fatal and nonfatal ASCVD, assessed using the Harrell C statistic, calibration, and net reclassification improvement (NRI) for newly defined ASCVD risk categories: low (&amp;lt;3%); borderline (3% to &amp;lt;5%); intermediate (5% to &amp;lt;10%); and high (\u226510%).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 6098 participants were included. At baseline, participant mean age was 61.4 (SD, 9.6) years, 52% were female, mean estimated 10-year ASCVD risk was 6.4% (SD, 4.8%) with the PREVENT-ASCVD base equations, and 49% had a CAC score greater than 0. During 10 years of follow-up, 366 (6%) experienced an ASCVD event. The Harrell C statistic for the PREVENT-ASCVD base equations was 0.73 (95% CI, 0.70-0.75). After adding CAC to the PREVENT-ASCVD base equations, the change in Harrell C statistic was 0.02 (95% CI, 0.01-0.03), and the categorical NRI was 0.095 (95% CI, 0.053-0.137). The calibration slope for the PREVENT-ASCVD base equations was 1.09 (95% CI, 0.93-1.25), and for the PREVENT-ASCVD base plus CAC equations was 0.92 (95% CI, 0.81-1.03). Among those at borderline risk, incident ASCVD occurred in 1.9% of those with CAC score of 0, 3.9% with CAC greater than 0 and less than 100, 7.4% with CAC 100 or greater and less than 300, and 14.3% with CAC 300 or greater.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n Among US adults aged 45 to 79 years, addition of CAC score to the PREVENT-ASCVD equations across all risk groups overall only modestly improved and, in some groups, did not change model discrimination and reclassification. Reclassification results support selective use of CAC in those with borderline to intermediate risk estimated by the PREVENT-ASCVD equations.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jama.2026.13233","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T15:30:24Z","timestamp":1787758224000},"page":"1126","source":"Crossref","is-referenced-by-count":1,"title":["Predictive Utility of Coronary Artery Calcium Score Added to the PREVENT Atherosclerotic Cardiovascular Disease Equations"],"prefix":"10.1001","volume":"336","author":[{"given":"Xiaoning","family":"Huang","sequence":"first","affiliation":[{"name":"Northwestern University Feinberg School of Medicine, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia C.","family":"Petito","sequence":"additional","affiliation":[{"name":"Northwestern University Feinberg School of Medicine, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norrina B.","family":"Allen","sequence":"additional","affiliation":[{"name":"Northwestern University Feinberg School of Medicine, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ron","family":"Blankstein","sequence":"additional","affiliation":[{"name":"Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger S.","family":"Blumenthal","sequence":"additional","affiliation":[{"name":"Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josef","family":"Coresh","sequence":"additional","affiliation":[{"name":"New York University Grossman School of Medicine, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"Greenland","sequence":"additional","affiliation":[{"name":"Northwestern University Feinberg School of Medicine, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer E.","family":"Ho","sequence":"additional","affiliation":[{"name":"Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amit","family":"Khera","sequence":"additional","affiliation":[{"name":"University of Texas Southwestern Medical Center, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donald M.","family":"Lloyd-Jones","sequence":"additional","affiliation":[{"name":"Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janani","family":"Rangaswami","sequence":"additional","affiliation":[{"name":"The George Washington University School of Medicine, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James H.","family":"Stein","sequence":"additional","affiliation":[{"name":"University of Wisconsin School of Medicine and Public Health, Madison"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiadi E.","family":"Ndumele","sequence":"additional","affiliation":[{"name":"Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sadiya S.","family":"Khan","sequence":"additional","affiliation":[{"name":"Northwestern University Feinberg School of Medicine, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nilay S.","family":"Shah","sequence":"additional","affiliation":[{"name":"Northwestern University Feinberg School of Medicine, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"11","key":"joi260082r1","doi-asserted-by":"publisher","first-page":"e596","DOI":"10.1161\/CIR.0000000000000678","article-title":"2019 ACC\/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines.","volume":"140","author":"Arnett","year":"2019","journal-title":"Circulation"},{"issue":"25","key":"joi260082r2","doi-asserted-by":"publisher","first-page":"e1082","DOI":"10.1161\/CIR.0000000000000625","article-title":"2018 AHA\/ACC\/AACVPR\/AAPA\/ABC\/ACPM\/ADA\/AGS\/APhA\/ASPC\/NLA\/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines.","volume":"139","author":"Grundy","year":"2018","journal-title":"Circulation"},{"issue":"17","key":"joi260082r3","doi-asserted-by":"publisher","first-page":"e1154","DOI":"10.1161\/CIR.0000000000001423","article-title":"2026 ACC\/AHA\/AACVPR\/ABC\/ACPM\/ADA\/AGS\/APhA\/ASPC\/NLA\/PCNA guideline on the management of dyslipidemia: a report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines.","volume":"153","author":"Blumenthal","year":"2026","journal-title":"Circulation"},{"issue":"24","key":"joi260082r4","doi-asserted-by":"publisher","first-page":"1982","DOI":"10.1161\/CIR.0000000000001191","article-title":"Novel prediction equations for absolute risk assessment of total cardiovascular disease incorporating cardiovascular-kidney-metabolic health: a scientific statement from the American Heart Association.","volume":"148","author":"Khan","year":"2023","journal-title":"Circulation"},{"issue":"6","key":"joi260082r5","doi-asserted-by":"publisher","first-page":"430","DOI":"10.1161\/CIRCULATIONAHA.123.067626","article-title":"Development and validation of the American Heart Association\u2019s PREVENT equations.","volume":"149","author":"Khan","year":"2024","journal-title":"Circulation"},{"issue":"15","key":"joi260082r6","doi-asserted-by":"publisher","first-page":"1657","DOI":"10.1016\/j.jacc.2015.07.066","article-title":"Implications of coronary artery calcium testing among statin candidates according to American College of Cardiology\/American Heart Association cholesterol management guidelines: MESA (Multi-Ethnic Study of Atherosclerosis).","volume":"66","author":"Nasir","year":"2015","journal-title":"J Am Coll Cardiol"},{"issue":"6, pt 1","key":"joi260082r7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacadv.2025.101825","article-title":"PREVENT risk score vs the pooled cohort equations in MESA.","volume":"4","author":"Murphy","year":"2025","journal-title":"JACC Adv"},{"issue":"11","key":"joi260082r8","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.124.038991","article-title":"Real-world evidence linking the predicting risk of cardiovascular disease events risk score and coronary artery calcium.","volume":"14","author":"Rhee","year":"2025","journal-title":"J Am Heart Assoc"},{"issue":"1","key":"joi260082r9","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1016\/j.jcct.2024.08.002","article-title":"Regional and socioeconomic disparities in calcium scans.","volume":"19","author":"Sachs","year":"2025","journal-title":"J Cardiovasc Comput Tomogr"},{"issue":"9","key":"joi260082r10","doi-asserted-by":"publisher","first-page":"871","DOI":"10.1093\/aje\/kwf113","article-title":"Multi-Ethnic Study of Atherosclerosis: objectives and design.","volume":"156","author":"Bild","year":"2002","journal-title":"Am J Epidemiol"},{"issue":"8","key":"joi260082r11","doi-asserted-by":"publisher","first-page":"810","DOI":"10.1001\/jamacardio.2025.1603","article-title":"AHA PREVENT equations and lipoprotein(a) for cardiovascular disease risk: insights from MESA and the UK Biobank.","volume":"10","author":"Bhatia","year":"2025","journal-title":"JAMA Cardiol"},{"issue":"8","key":"joi260082r12","doi-asserted-by":"publisher","first-page":"818","DOI":"10.1001\/jamacardio.2025.1591","article-title":"AHA PREVENT equations with lipoprotein(a) and risk assessment for primary prevention.","volume":"10","author":"Lloyd-Jones","year":"2025","journal-title":"JAMA Cardiol"},{"issue":"10","key":"joi260082r13","doi-asserted-by":"publisher","first-page":"1071","DOI":"10.1001\/jamacardio.2025.2725","article-title":"Statin eligibility according to atherosclerotic cardiovascular disease risk in the US.","volume":"10","author":"Khan","year":"2025","journal-title":"JAMA Cardiol"},{"issue":"9","key":"joi260082r14","doi-asserted-by":"publisher","first-page":"876","DOI":"10.1001\/jamacardio.2025.1865","article-title":"Performance of the American Heart Association\u2019s PREVENT equations among disaggregated racial and ethnic subgroups.","volume":"10","author":"Yan","year":"2025","journal-title":"JAMA Cardiol"},{"issue":"17","key":"joi260082r15","doi-asserted-by":"publisher","first-page":"2408","DOI":"10.1161\/CIRCULATIONAHA.109.192278","article-title":"Criteria for evaluation of novel markers of cardiovascular risk: a scientific statement from the American Heart Association.","volume":"119","author":"Hlatky","year":"2009","journal-title":"Circulation"},{"issue":"12","key":"joi260082r16","doi-asserted-by":"publisher","first-page":"961","DOI":"10.1001\/jama.2024.13887","article-title":"Statins for primary prevention of cardiovascular disease\u2014with PREVENT, what\u2019s a clinician to do?","volume":"332","author":"Khan","year":"2024","journal-title":"JAMA"},{"issue":"20","key":"joi260082r17","doi-asserted-by":"publisher","first-page":"1768","DOI":"10.1001\/jama.2023.7575","article-title":"Coronary artery calcium score and polygenic risk score for the prediction of coronary heart disease events.","volume":"329","author":"Khan","year":"2023","journal-title":"JAMA"},{"issue":"4","key":"joi260082r18","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.124.039454","article-title":"Evaluation and comparison of the PREVENT and pooled cohort equations for 10-year atherosclerotic cardiovascular risk prediction.","volume":"14","author":"Zhou","year":"2025","journal-title":"J Am Heart Assoc"},{"issue":"7","key":"joi260082r19","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.26230","article-title":"Estimated prevalence and testing for albuminuria in US adults at risk for chronic kidney disease.","volume":"6","author":"Chu","year":"2023","journal-title":"JAMA Netw Open"},{"key":"joi260082r20","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1016\/j.amjcard.2022.03.019","article-title":"Effect of no-charge coronary artery calcium scoring on cardiovascular prevention.","volume":"174","author":"Al-Kindi","year":"2022","journal-title":"Am J Cardiol"},{"issue":"19","key":"joi260082r21","doi-asserted-by":"publisher","first-page":"e391","DOI":"10.1161\/CIR.0000000000001382","article-title":"Opportunistic detection of coronary artery calcium on noncardiac chest computed tomography: an emerging tool for cardiovascular disease prevention: a scientific statement from the American Heart Association.","volume":"152","author":"Foraker","year":"2025","journal-title":"Circulation"},{"issue":"7","key":"joi260082r22","doi-asserted-by":"publisher","first-page":"928","DOI":"10.1161\/CIRCULATIONAHA.106.672402","article-title":"Use and misuse of the receiver operating characteristic curve in risk prediction.","volume":"115","author":"Cook","year":"2007","journal-title":"Circulation"},{"issue":"8","key":"joi260082r23","doi-asserted-by":"publisher","first-page":"971","DOI":"10.1093\/aje\/kwq223","article-title":"External validity of risk models: use of benchmark values to disentangle a case-mix effect from incorrect coefficients.","volume":"172","author":"Vergouwe","year":"2010","journal-title":"Am J Epidemiol"},{"issue":"1","key":"joi260082r24","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1161\/CIR.0000000000001145","article-title":"Epidemiology of diabetes and atherosclerotic cardiovascular disease among Asian American Adults: implications, management, and future directions: a scientific statement from the American Heart Association.","volume":"148","author":"Kwan","year":"2023","journal-title":"Circulation"},{"issue":"3","key":"joi260082r25","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCIMAGING.124.016599","article-title":"Race- and sex-specific age at which coronary artery calcium becomes detectable among young adults.","volume":"18","author":"Yeboah-Kordieh","year":"2025","journal-title":"Circ Cardiovasc Imaging"}],"container-title":["JAMA"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jama\/articlepdf\/2853347\/jama_huang_2026_oi_260082_1790281448.72792.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T15:00:26Z","timestamp":1791298826000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/2853347"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,6]]},"references-count":25,"journal-issue":{"issue":"13","published-print":{"date-parts":[[2026,10,6]]}},"URL":"https:\/\/doi.org\/10.1001\/jama.2026.13233","relation":{},"ISSN":["0098-7484"],"issn-type":[{"value":"0098-7484","type":"print"}],"subject":[],"published":{"date-parts":[[2026,10,6]]}}}