For a study, researchers sought to locate, evaluate, and summarise any cohort studies that compared CVD (cardiovascular disease) risk score + CACS (coronary artery calcium scores) to CVD risk score alone when using a conventional cardiovascular disease (CVD) risk calculator (or CVD risk factors using a standard calculator). About 6 eligible cohort studies were selected from 2,772 records screened (with 1,043 CVD occurrences in 17,961 unique people) from the United States (n=3), the Netherlands (n=1), Germany (n=1), and South Korea (n=1). The number of participants in the studies ranged from 470 to 5,185. (range of mean [SD] ages, 50 [10] to 75.1 [7.3] years; 38.4% -59.4% were women). The C statistic of CVD risk models without CACS varied from 0.693 (95% CI, 0.661-0.726) to 0.80. Adding CACS resulted in a 0.036 increase in C statistic (95% CI, 0.020-0.052). During follow-up, 85.5% (65 of 76) to 96.4% (349 of 362) of patients categorized as low risk by the risk score and reclassified as intermediate or high risk by CACS did not experience a CVD event (range, 5.1-10.0 years). During follow-up, 91.4% (202 of 221) to 99.2% (502 of 506) of patients categorized as high risk by the risk score and reclassified as low risk by CACS did not experience a CVD incident. The CACS appeared to offer some additional discrimination to the standard CVD risk assessment equations employed in this research, according to this systematic review and meta-analysis, which appeared to be rather consistent across investigations. However, expenses, frequencies of accidental finds, and radiation dangers might sometimes offset the little advantage. Although the CACS might have a function in improving risk assessment in some patients, it was unclear which patients might benefit. No evidence adding CACS to standard risk scores improves therapeutic outcomes.