Higher levels of coronary artery calcium (CAC) are associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD). Recent studies have suggested that CAC value might also help determine the net benefit of aspirin therapy. This study aims to evaluate the association between CAC, ASCVD, and bleeding, along with the net effect of aspirin at different CAC levels.

This prospective, population-based cohort study included a total of 2,191 participants who were free from ASCVD and were not taking aspirin at baseline. The CAC scores of the participants were calculated and classified into the following categories: 0, 1-99, and 100+. The primary outcome of the study was ASCVD events, major bleeding, and aspirin effect estimates.

A total of 116 major bleeding and 123 ASCVD events were reported over a median follow-up of 12.2 years. The findings suggested that higher CAC categories (1-99 and 100+) were associated with a higher risk of both ASCVD and bleeding events. However, the association was marked as statistically insignificant after multivariable adjustment. The net benefit of aspirin was identified in patients with a CAC score of at least 100 who were at a lower bleeding risk.

The research concluded that higher CAC was associated with a higher risk of ASCVD and bleeding events. A higher CAC score and low bleeding were associated with a higher net benefit of aspirin.

Ref: https://jamanetwork.com/journals/jamacardiology/article-abstract/2772390?resultClick=1