Studies suggest that we may have been underestimating the value of calcium scoring for detecting and managing patients with known or suspected coronary disease.
Not only it can but it is currently the most stronger predictor of CAD in asymptomatic patients, much stronger than any other imaging method, laboratory measurement or even combined clinical risk scores.
In my opinion, the true role of coronary calcium score to assess long-term cardiovascular risk is that to relate this parameter higly predictive of coronary artery disease to the association with other major coronary risk factors primarily LDL-Cholesterol concentrations, which strongly contribute to the development and progress of atherosclerotic plaque in the coronary arteries.
Calcium Score has been investigated for more than 2 decades. It is certainly of major importance in asymptomatic individuals. There are however no real strong guidelines. Primary prevention may benefit significantly especially when the estimated risk is intermediate. Calcium score is specific for coronary artery related events (obstruction, thrombosis) and should help modulating pharmacological therapy of individuals at risk by reassigning the risk category.