American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the coronary artery calcium score threshold for initiating statin therapy?

1. Less than 50

2. 50 to 99

3. 100

4. 200

The correct answer is: 100

The coronary artery calcium (CAC) score is a useful tool in assessing the risk of coronary artery disease and can guide the decision to initiate statin therapy. A CAC score of 100 is significant because it indicates a higher level of calcified plaque within the coronary arteries, which correlates with an increased risk of cardiovascular events. When evaluating patients for statin therapy, particularly those within intermediate risk categories, a CAC score of 100 or greater serves as a threshold suggesting that the benefits of statin treatment are likely to outweigh the risks. This score, therefore, supports the notion that there is enough atherosclerotic burden present, warranting consideration of aggressive lipid-lowering therapy to mitigate further cardiovascular risk. Scores below 100 could indicate either a lower risk or insufficient evidence to justify statin use in the absence of additional factors, such as family history or other risk factors. Thus, a score of 100 is clinically relevant in guiding healthcare providers on whether to start statin treatment in their patients.