Coronary artery calcium score (CAC)
Diagnostics · CV imaging
Tier A+
What this is
Rule of thumb: CAC 0 in age 60+ allows very conservative primary prevention; CAC >100 often mandates aggressive statin regardless of cholesterol. MESA risk calculator incorporates CAC. Watch for the 'warranty period' debate — how long does CAC 0 stay protective (Blaha 2019 suggests 3-5 years).
Mechanism
Non-contrast CT quantifying calcified plaque in coronary arteries; Agatston score directly visualizes atherosclerotic burden; CAC 0 = very low near-term CV risk; CAC >100 = significantly elevated risk regardless of other factors
Dose & route
Once >40 as baseline; repeat q3-5 years if initially 0 (progression pattern has research support but timing debated)
Citations
- https://pubmed.ncbi.nlm.nih.gov/29146535/
- https://pubmed.ncbi.nlm.nih.gov/32008920/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC6675035/
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This is an independent synthesis of published research by a non-clinician. Scores are opinions supported by citations, not prescriptions. See the full disclaimer and methodology for how this score was produced and what it does and doesn't mean.