Seeing Atherosclerosis: How Coronary Calcium Transforms Risk Assessment

Coronary artery calcium (CAC) scoring has emerged as one of the most powerful tools for refining cardiovascular risk assessment in asymptomatic individuals. A CAC score of zero is associated with extremely low event rates even among those with multiple risk factors, while elevated scores identify individuals who benefit most from preventive therapies. Yet despite robust evidence and guideline endorsement, CAC scoring remains underutilized in clinical practice. In this episode of "The Heart of Prevention," Dr. Michael Blaha and Dr. Khurram Nasir explore how CAC scoring transforms primary prevention from a population-based approach to truly personalized medicine. They discuss the "power of zero"—how the absence of coronary calcium can safely defer or avoid certain preventive therapies—and how elevated scores guide intensification of treatment, from statins to aspirin and beyond.

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