The authors divided study participants by the AHA/ACC calcium risk categories – 0, 1-99, and 100 or above – to evaluate how useful the calcium scores would have been in predicting heart attacks and strokes. It also subdivided the participants by sex and race (Black, white, and Hispanic) to calculate the risk levels for the different groups.

For participants with a calcium score of zero, there was a similarly low risk of either a stroke or a heart attack in the coming 10 years – less than 2 percent for either event among all study participant categories, according to the study.


The risk level for both heart attacks and strokes rose a bit for those with scores of 1-99, yet still remained below 6 percent – increasing about equally for both and across most demographic groups. At this level, women did have a greater increase in the risk for stroke than for heart attack, whereas men had higher heart attack risk than stroke.

Greater differences were found when the CAC scores rose to 100 or above, with heart attack risk twice as high as stroke risk for the entire study population. While 10-year heart attack risk jumped above 12 percent for men and over 14 percent for Hispanic individuals, heart attack risk for women was approximately 8 percent, according to the study.

Meanwhile, stroke risk remained below 8 percent across all groups, although women, Black, and Hispanic people had higher risk than men and white participants.

For doctors and patients, the findings could help tilt the scales either toward or away from using statin drugs to lower cholesterol in cases where the decision is not clear-cut from factors such as age, sex, cholesterol, systolic blood pressure, and smoking history.

Patients are sometimes reluctant to begin what is likely to become a lifelong drug therapy, Joshi says. “If you think your patient should be on a statin and your patient doesn’t want to take it, this can be a good arbitrator of that,” he says. “Our findings also highlight some of the nuance between heart attack risk and stroke risk and how our patients might consider those two risks in their decision-making.”

Researchers at Emory University School of Medicine, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins School of Medicine, Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, the University of California Los Angeles Medical Center, and Houston Methodist Hospital participated in the study.

Funding was provided by the National Heart, Lung, and Blood Institute; the National Center for Advancing Translational Sciences; and the Donald W. Reynolds Foundation. Some researchers received awards, grants, or fees from the American Heart Association, the Abraham J. & Phyllis Katz Foundation, Novo Nordisk, Sanofi/Regeneron, GlaxoSmithKline, AstraZeneca, Pfizer, Bayer, or Regeneron. Joshi holds equity interest in Global Genomics Group.

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