Coronary artery calcification distribution and progression in over 70 000 asymptomatic individuals: Implications for assessment intervals and optimal testing age

Aims To assess the prevalence and progression of CAC in asymptomatic individuals and evaluate the duration for which a CAC score of 0 persists over time. Methods and results This retrospective cohort study included 70 389 asymptomatic individuals aged over 30 years from Korea, with at least two CAC score assessments (2010-22). Subgroups were defined based on follow-up intervals: The entire cohort, those with at least four assessments within 10 years, and those with follow-up after five years. Analyses focused on age-and sex-specific CAC distributions, incidence and timing of new CAC, and changes in CAC scores among those with an initial score of 0 over 6-12 years. Among participants (mean age 40.5 ± 6.6 years; 87% men), 84% had a baseline CAC score of 0, and 3% had scores > 100. Notably, 93% of women had a CAC score of 0, with the highest percentages observed in younger women. Incident CAC developed in 16% of participants with an initial score of 0 within five to six years, with just 1% exceeding score of 100. Extended follow-up data showed a consistently low prevalence of significant CAC scores, with only 4% exceeding scores > 100 after 10 years. Conclusion In a large Korean cohort of over 70 000 asymptomatic adults, most had baseline CAC = 0, indicating low subclinical atherosclerosis. Significant calcification (CAC > 100) was rare within 5-6 years, with only 4% exceeding 100 by 10 years, even among older subgroups.