Extensive data demonstrate that coronary artery calcium (CAC) scoring powerfully stratifies cardiovascular risk beyond traditional risk factors.1 Budoff et al. showed in 25,253 asymptomatic individuals that adding CAC to risk models markedly improved prediction (C-index 0.61 to 0.81).1 CAC burden correlates with incident events in a graded manner: patients with CAC >400 have substantially higher rates of myocardial infarction and death compared to those with CAC = 0123. The segment involvemen…