Commentaar: Coronaire calciumscores: Een panacee bij de predictie van hartinfarcten?

The prevention of coronary heart disease (CHD) is important. However, traditional CHD risk prediction models, e.g. based on cholesterol levels and blood pressure, are not accurate enough, particularly in women and in the elderly. New markers are therefore being intensively investigated; these include coronary artery calcification (CAC) scores. This article discusses a recent publication which demonstrated that CAC testing did indeed lead to improved CHD risk prediction in a large cohort of individuals that had not yet been diagnosed with CHD. Although the effect in the low-risk group was statistically eminent, its clinical benefit is small. In addition, several drawbacks of CAC testing are discussed, such as the increased costs, radiation exposure, more unnecessary downstream cardiac testing (non-invasive and invasive) in subjects with high CAC scores, and the impact on the quality of life. Although potentially promising, CAC testing should be evaluated in prospective randomized trials using the aspects mentioned above as endpoints before being implemented in daily practice.