Coronary Calcium Scoring: A Smarter Way to Prevent Heart Disease
❤️ February is American Heart Month, a time to spotlight the #1 killer of both men and women in the United States: cardiovascular disease*. Cardiovascular disease claims hundreds of thousands of lives annually and affects millions more - with women bearing a huge portion of the burden. Over 60 million U.S. women (about 44 %) are living with some form of heart disease, which is responsible for roughly 1 in 5 female deaths each year - yet awareness remains alarmingly low.
Coronary Artery Calcium (CAC) CT Scan
One of the most useful tools in preventive cardiology is the Coronary Artery Calcium (CAC) CT scan - a quick, painless, non-contrast, non-invasive imaging test that measures calcified plaque in the coronary arteries. CAC scoring doesn’t just give you a number; it shows how much plaque is present and helps predict a person’s real risk of a heart attack or other cardiac event.
CAC Scores Change the Conversation About Risk
Traditional risk calculators (based largely on age, cholesterol, blood pressure, and smoking history) can miss a lot of people who are actually building plaque. CAC scoring fills that gap by directly measuring calcified atherosclerosis, making risk real rather than estimated.
Evidence shows that knowing your CAC score can help guide care and improve results. A 2025 randomized clinical trial published in JAMA looked at asymptomatic, intermediate-risk adults with family histories of premature coronary artery disease. Participants were randomized either to usual care or to a care strategy guided by their CAC score. Over three years, those whose preventive plans were informed by CAC scores - including tailored lifestyle counseling and statin therapy - had significantly less progression of total plaque, noncalcified plaque, and high-risk plaque components on follow-up imaging compared with usual care. They also saw meaningful reductions in LDL cholesterol and overall estimated cardiovascular risk.
What this means in plain terms: knowing your CAC score doesn’t just tell you you’re at risk - it identifies who may benefit from a more aggressive prevention strategy, including lipid-lowering therapies, lifestyle interventions, and/or tighter metabolic control. It allows us to act early and slow the disease process before symptoms or events occur.
Practical and Patient-Friendly
Unlike stress tests or angiography:
CACT scans are painless.
They use no intravenous contrast.
They are non-invasive and quick (often under 10 minutes).
They are relatively inexpensive** compared to many cardiovascular imaging tests - which is why more preventive guidelines are considering its role in routine risk assessment.
Limitations of CAC Scoring
While CAC scoring is highly informative, it does have limitations. It detects calcified plaque, but not soft (non-calcified) plaque, which can also be clinically significant. A zero score doesn’t eliminate cardiovascular risk, particularly in younger patients, smokers, those with diabetes, or individuals with strong family histories of premature coronary disease. CAC also doesn’t measure functional ischemia — it’s a structural assessment, not a stress test.
Despite these limitations, CAC remains one of the most practical and actionable tools for refining risk and guiding preventive strategies.
Bottom Line
Traditional risk calculators can underestimate cardiovascular risk, especially in women. CAC scoring fills that gap by showing actual plaque burden and clarifying who is truly at risk. It allows clinicians to intervene earlier and with more precision, rather than waiting for symptoms or events to declare themselves.
*The term “cardiovascular disease” includes heart disease, stroke, heart failure, and problems with circulation.
**My patients typically pay $150 for a CACT scan. These scans are not typically covered by insurance.
Are you ready to take a more PROACTIVE approach to your health? I can help! As a board-certified Integrative & Functional Medicine physician and Certified Menopause Specialist, I can help you “think outside of the box and dig deeper with a variety of laboratory testing to help uncover the root causes of your symptoms, and create a plan personalized for you that goes beyond the prescription pad to incorporate diet/lifestyle change, nutritional supplements, holistic therapies, health coaching and more! Contact us to get started!