Investigators of the Dallas Heart Study sought to determine whether using coronary artery calcium (CAC) screening to refine coronary heart disease risk assessment (Framingham Risk Score) in moderately high-risk individuals is clinically useful. Of the 2,610 subjects of the study, 1.0% of women and 15.4% of men were at moderately high-risk based on the Framingham Risk Score. Using a CAC threshold ≥400, <0.1% of women and 1.1% of men were upgraded from moderately high-risk to high-risk categories. Analyses performed in an older age range (45-65 years) or the broader moderately high-risk category (10-year risk of 6-20% instead of 10-20%) had no impact on risk assessment in women. Additional analyses performed from low-risk to moderately high-risk categories were more efficient. Therefore, CAC screening strategies focused on moderately high-risk subjects have a minor impact on risk assessment in women and a modest impact in men.
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