To the Editor: In their cohort study, Dr Polonsky and colleagues1 confirmed that coronary calcification is a significant predictor of cardiovascular events. However, several important questions remain unanswered.
The coronary artery calcium score (CACS) has a very poor ability to discriminate between those who will and those who will not experience a clinical cardiovascular event. In this study with a median of 5.8 years of follow-up, 122 acute cardiovascular events occurred among the 5878 participants (aged 45-84 years; mean age, 62 years). The majority of persons with coronary calcium will not experience a clinical event,2 and because approximately one-third of the middle-aged population and almost 100% of the older population have coronary calcification,3 the performance of a CACS test may cause unnecessary anxiety in the general population.
Axel Diederichsen, Hans Mickley. Coronary Artery Calcium Score and Cardiovascular Event Prediction. JAMA. 2010;304(7):741–742. doi:10.1001/jama.2010.1142