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

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.

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.

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.