Your Arterial Plaque Photograph
The CAC score directly photographs calcium deposits in your coronary arteries via CT scan. Unlike blood tests that measure risk factors, CAC shows the ACTUAL disease. Score of 0 = no calcified plaque (excellent prognosis). Any score >0 = plaque exists. It's the single most powerful predictor of cardiovascular events in asymptomatic people.
What is Coronary Artery Calcium Score?
CAC uses non-contrast cardiac CT with Agatston scoring. Measures calcified (stable) plaque—doesn't detect soft/vulnerable plaque. Scores: 0 = none, 1-99 = mild, 100-399 = moderate, ≥400 = severe. Best for risk reclassification in 40-75 year-olds with intermediate risk.
↑ What High Coronary Artery Calcium Score Means
Established coronary atherosclerosis. >100 = significant disease. >400 = extensive disease with high event risk. This result should drive aggressive prevention.
Common symptoms:
Usually asymptomatic (that's why screening matters) · Angina if significant obstruction · Shortness of breath on exertion
↓ What Low Coronary Artery Calcium Score Means
Score of 0: very low risk. May justify deferring statin in intermediate-risk patients.
Common symptoms:
No symptoms—screening test
Why It Matters
When normal:
Most powerful CVD predictor in asymptomatic individuals
Score 0: >99% 10-year negative predictive value
Reclassifies intermediate-risk patients
Motivates patient adherence
Risks if abnormal:
>0: plaque exists
>100: statin recommended regardless of LDL
>400: high risk, aggressive intervention
Only detects calcified plaque
What Can Cause Abnormal Levels?
Atherosclerosis (cumulative lifetime exposure)
70% likelyCAC reflects decades of risk factor exposure. It's the sum total of plaque buildup.
Age
60% likelyMost men >60 and women >70 have some calcium.
Hypertension
Accelerates plaque formation.
Dyslipidemia
High LDL drives cholesterol deposition.
Diabetes
Accelerated atherosclerosis.
Smoking
Strongest modifiable accelerator.
Family History
Genetic predisposition to early atherosclerosis.
What You Can Do
CAC cannot decrease (calcium is permanent)
Impact: Goal: slow progression and stabilize plaques \u00B7 Timeline: Ongoing
Mediterranean diet, exercise, don't smoke
Impact: Slows plaque progression \u00B7 Timeline: Ongoing
If CAC = 0: repeat in 5-10 years
Impact: Zero score is very reassuring \u00B7 Timeline: 5-10 years
If lifestyle changes aren't enough:
Aggressive LDL/ApoB optimization if CAC >0
Impact: Reduces further cholesterol deposition \u00B7 Timeline: 4-8 weeks
Blood pressure <130/80
Impact: Reduces mechanical stress on plaques \u00B7 Timeline: Ongoing
Recommended retest: Not routine—5 years if baseline zero; no repeat if already >0
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