Atherosclerotic cardiovascular disease （ASCVD）,including coronary heart disease, remains a major cause of death and disability among developed countries. Coronary artery calcification （CAC）, which is detected by computed tomography scanning, is a well-known measure of subclinical atherosclerosis. CAC is considered to have important implications for understanding the long-term accumulated burden of cardiovascular risk factors and for the possibility of reclassification at the preclinical phase for preventing ASCVD. This review focuses on CAC and its usability in primary prevention of ASCVD. Numerous epidemiological studies, mainly in Western countries, have indicated that, among asymptomatic individuals, the CAC score is associated with future ASCVD. Additionally, the CAC score provides improved predictive values for estimating the risk of ASCVD beyond traditional cardiovascular risk factors. However, a lack of evidence for this score in other populations warrants further investigations. Clinical trials are also necessary to demonstrate the usefulness and safety of CAC screening for primary prevention of ASCVD.