The following are key points to remember about this editorial comment on imaging atherosclerosis for global predictive health and wellness:

1. Coronary artery calcium (CAC) scoring has been at the core of screening tests applied for more than a decade and has a well-established body of evidence for detecting preclinical coronary disease and effective prognostication for cardiovascular events (CVEs).
2. Remarkably, using the MESA (Multi-Ethnic Study of Atherosclerosis) study, CAC not only correlated with CVEs, but was also a long-term (median ~10 years) predictor of noncardiovascular conditions such as cancer, pneumonia, chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), and hip fracture. The CAC score is also strongly predictive of all-cause mortality at 15-year follow-up.
3. Rather than CAC being a predictor of all important diseases, it is more likely that vascular aging has a proportional relationship with chronological age. Common diseases advance with age together including the prevalence of cardiovascular disease (CVD) increasing (including CAC) with age and non-CVD conditions such as COPD, cancer, pneumonia, pulmonary embolism, and dementia.
4. In MESA, comparing CAC >400 with CAC = 0, the relative hazard was 1.53 for cancer, 1.70 for CKD, 1.97 for pneumonia, 2.71 for COPD, and 4.29 for hip fracture, but no difference in deep vein thrombosis/pulmonary embolism or dementia.
5. It is not all age considering that the pathogenesis of many of the non-CVDs involves many of the CVD risk factors including oxidative stress, smoking, chronic inflammation, diabetes, exercise, and nutrition.
6. As the authors state, while subject to criticism and not a reimbursable procedure, the accumulating evidence supports the need for a thoughtful discussion regarding CAC scoring being a valuable tool to guide health care decision making.

Keywords: Atherosclerosis, Dementia, Diabetes Mellitus, Diagnostic Imaging, Geriatrics, Hip Fractures, Neoplasms, Oxidative Stress, Pneumonia, Primary Prevention, Pulmonary Disease, Chronic Obstructive, Pulmonary Embolism, Renal Insufficiency, Chronic, Risk Factors, Smoking, Vascular Calcification

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