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There is some disparity in the morbidity and mortality rates of cardiovascular disease (CVD) according to race, ethnicity, and geographicregions. Although prediction algorithms that evaluate risk of cardiovascular events have been established using traditionalrisk factors, they have also demonstrated a number of differences along with race and ethnicity. Of various risk assessment modalities,coronary artery calcium (CAC) score is a sensitive marker of calcific atherosclerosis and correlates well with atheroscleroticplaque burden. Although CAC score is now utilized as a useful tool for early detection of coronary artery disease, prior studieshave suggested some variability in the presence and severity of coronary calcification according to race, ethnicity, and/or geographicregions. Among Asian populations, it would appear necessary to reappraise the utility of CAC score and whether it remainssuperior over and above established clinical risk prediction algorithms. To this end, the Korea initiatives on coronary arterycalcification (KOICA) registry has been designed to identify the effectiveness of CAC score for primary prevention of CVD in asymptomaticKorean adults. This review discusses the important role of CAC score for prognostication, while also describing thedesign and rationale of the KOICA registry.

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