Inflammatory conditions like lupus, rheumatoid arthritis, and psoriatic disease already raise heart attack and stroke risks. A new study published in the Journal of the American College of Cardiology: Cardiovascular Imaging shows coronary artery calcium (CAC) scores from routine chest CT scans can spot danger early in these patients. 
Researchers at two Boston centers reviewed 2,546 adults aged 40-70 with these immune-mediated inflammatory diseases (IMIDs). None had prior heart disease. They used AI to measure CAC on scans done for regular care from 2000-2023. Follow-up averaged 8.1 years. Only 6% took statins at start. The goal is to link CAC levels to death or major heart events like heart attack, stroke, or revascularization.
CAC Shows Up Often in IMID Patients
Over half—53%—had some CAC (CAC-AI >0). Women made up 66.5%, median age 59. Even mild buildup (CAC 1-99) show trouble. Compared to zero CAC, it raised all-cause death risk by 41% (adjusted HR 1.41, P=0.010). Heart events jumped over twofold (HR 2.05, P<0.001). Heavy CAC (≥100) hit harder: 2.45 times death risk (P<0.001) and 3.24 times heart events (P<0.001). Models adjusted for age, sex, smoking, diabetes, blood pressure, and cholesterol. Numbers held firm.
Why This Matters for High-Risk Groups
IMID patients face extra heart plaque from ongoing inflammation, not just standard risks. Routine chest CTs, ordered for lung checks or cancer screens, often catch heart calcium by chance. This AI tool pulls CAC scores fast and accurately, no extra radiation. Think of a rheumatoid arthritis patient getting a CT for joint pain workup. Spot CAC 50? That's a wake-up—start statin, aspirin, or tighter BP control. Study proves even low scores predict real harm in this undertreated group.
Everyday Clinic Impact
Statins sat unused in 94% despite high CAC rates. Inflammation drives silent plaque; traditional scores like Framingham miss it. CAC fills the gap, much like in general populations but amplified here. Rheumatologists and cardiologists should flag these scans. Report CAC to guide talks—"Your calcium score triples heart risk; let's add a pill." No prior events mean early wins.
Call to Action for Doctors
In patients with immune-mediated inflammatory disease, review their recent chest CT scan. Any CAC >0 doubles heart event risk. CAC ≥100 triples it. This holds after adjusting for age 55, female sex, and no smoking history. Current guidelines do not yet recommend routine CAC, but this observational data supports early prevention. Consider adding hsCRP or Lp(a) tests for better risk assessment. In future practice, include CAC scoring in IMID protocols similar to HbA1c monitoring in diabetes.