Don’t be Fooled by Coronary Artery Calcium score of 0…

Physionic

Jan 5, 2026

Episode description

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0:00 - Introduction
1:10 - Understanding Coronary Artery Calcium
2:27 - A False Sense of Security
5:00 - Higher CAC... Better? Sometimes.
7:35 - A Better Test
9:38 - Think of it this way…

References [Funding/Conflicts of Interest are supplied in the free article available in the Free Physionic Community or in the email list - they don't fit in the description]

[Study 573] Onnis C, Virmani R, Kawai K, et al. Coronary artery calcification: current concepts and clinical implications. Circulation. 2024;149:251-266. doi:10.1161/CIRCULATIONAHA.123.065657.

[Study 574] Sama C, Abdelhaleem A, Velu D, et al. Non-calcified plaque in asymptomatic patients with zero coronary artery calcium score: A systematic review and meta-analysis. J Cardiovasc Comput Tomogr. 2024;18(1):43-49. doi:10.1016/j.jcct.2023.10.002

[Study 575] Williams MC, Kwiecinski J, Doris M, et al. Low-Attenuation Noncalcified Plaque on Coronary Computed Tomography Angiography Predicts Myocardial Infarction: Results From the Multicenter SCOT-HEART Trial (Scottish Computed Tomography of the HEART). Circulation. 2020;141(18):1452-1462. doi:10.1161/CIRCULATIONAHA.119.044720

[Study 576] Budoff MJ, McClelland RL, Nasir K, et al. Cardiovascular events with absent or minimal coronary calcification: the Multi-Ethnic Study of Atherosclerosis (MESA). Am Heart J. 2009;158(4):554-561. doi:10.1016/j.ahj.2009.08.007

[Study 577] Budoff MJ, Young R, Burke G, et al. Ten-year association of coronary artery calcium with atherosclerotic cardiovascular disease (ASCVD) events: the multi-ethnic study of atherosclerosis (MESA). Eur Heart J. 2018;39(25):2401-2408. doi:10.1093/eurheartj/ehy217

[Study 578] Bergström G, Persson M, Adiels M, et al. Prevalence of Subclinical Coronary Artery Atherosclerosis in the General Population. Circulation. 2021;144(12):916-929. doi:10.1161/CIRCULATIONAHA.121.055340

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#coronaryarterydisease #heartdisease #heartdiseaseprevention

Mindsip insights from this episode:

Evaluate health metrics alongside zero CAC score for accurate plaque assessment

A CAC score of zero is only truly comforting if your other health metrics are good; if you have many risk factors, a zero score may not accurately reflect your real plaque status.

#plaque

#risk

Utilize CCTA to identify reversible soft plaque

The CCTA test is advantageous because it identifies soft plaque, which is generally considered more reversible than the hardened, calcified plaque.

#plaque

#screening

Stabilize plaque with drugs to improve health despite increased CAC score

Certain molecules and drugs can stabilize dangerous plaque by accelerating its calcification, which is a net health benefit even though it causes the CAC score to shoot up.

#plaque

Understand high CAC score as potential indicator of stabilized plaque

In some contexts, a high CAC score might be better than a low one because it can indicate that dangerous soft plaque has been stabilized into less risky, densely calcified plaque.

#plaque

#screening

Understand zero CAC score does not eliminate cardiac risk

A coronary artery calcium (CAC) score of zero does not guarantee you are free from the risk of a major cardiac event like a heart attack or stroke.

#heart

#risk

Clarify CAC score by separating plaque volume and density

The CAC score can be misleading because it combines plaque volume (bad) with plaque density (potentially good), making the final number difficult to interpret without context.

#plaque

#screening

Choose CCTA for accurate assessment of soft plaque risk

A CCTA (contrast coronary CT angiograph) is a superior test because it directly measures the dangerous soft plaque, not just the calcium that may or may not be present.