Coronary artery calcium score as a predictor for incident stroke: Systematic review and meta-analysis

Coronary calcium scoring is, by name and by habit, about the heart. This meta-analysis asks whether the same scan also forecasts strokes.

Pooling three prospective cohorts that followed more than 13,000 asymptomatic people for up to nearly a decade, the authors found that any detectable coronary calcium — a score above zero — nearly tripled the risk of a future stroke, with the risk climbing steadily across higher score categories. The signal was consistent, with no statistical heterogeneity between studies.

The practical takeaway widens the value of a scan many people already get: a calcium score speaks to cerebrovascular as well as coronary risk, which strengthens the case for acting on a positive result. The resistance is disciplinary — stroke prevention and neurology don’t currently fold coronary calcium into their risk thinking.

We rate the evidence strong, matching the source’s high-confidence assessment: a meta-analysis of prospective cohort data with zero measured heterogeneity and no declared conflicts is about as solid as observational evidence gets. The honest limit is that it rests on three studies and shows association, not a treatment effect — but the consistency and scale make it a credible reason to read a calcium score as a whole-body atherosclerosis signal.