The objective of this document is to review the clinical applicability of coronary artery calcium (CAC) scoring in both asymptomatic and symptomatic patients at risk for cardiovascular disease. We begin by describing the pathological basis of atherosclerosis, the characteristic stages of atherosclerotic plaque development, and the mechanism and role of arterial calcification in advanced atherosclerotic lesions. We also explain the utility of CAC scoring in cardiovascular risk assessment, discuss the most current clinical methods for measuring CAC, and examine major clinical studies reporting CAC scores in both asymptomatic and symptomatic heart patients. Lastly, the current recommendations for CAC scoring as stated by the American College of Cardiology/American Heart Association (ACC/AHA) are outlined, and a number of considerations for future research are provided. Atherosclerosis begins when certain factors cause chronic endothelial injury, which eventually leads to the build up of fibrofatty plaques in the intima of arterial blood vessels. In time, blood vessel walls can weaken, thrombi can form and plaques can send emboli to distal sites. There are six characteristic stages of
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