Should I Get a Coronary Calcium Scan?
Updated: May 27, 2025
For Informational Purposes Only
The information presented on this website is not a substitute for professional medical advice. Always consult a qualified health professional when deciding on medical care.
Overview
The Coronary Artery Calcium (CAC) test is a specialized CT scan that measures calcified plaque in coronary arteries to assess heart disease risk. This non-invasive screening tool provides a calcium score that helps doctors and patients make informed decisions about preventive treatments, particularly for those with unclear cardiovascular risk profiles.
What is a coronary calcium scan?
The CAC test is a specialized CT scan that measures the amount of calcified plaque in the coronary arteries. The result is expressed as a calcium score, which helps quantify the extent of coronary atherosclerosis. A higher calcium score correlates with a higher risk of future cardiovascular events, such as heart attacks.
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Does a coronary calcium scan work?
Yes, CAC scoring works effectively for short-term risk stratification, with higher scores correlating with greater ASCVD risk. A score of 0 indicates very low short-term risk but does not rule out non-calcified plaque or long-term risk. Importantly, up to one-third of cardiac events occur in individuals with a score of 0. In other words, while the number of people who have a score of 0 and experience a cardiac event is small, they still account for up to one-third of total cardiac events in absolute terms.
Why get a coronary calcium scan?
A CAC score is a risk assessment tool that is especially useful if your risk isn’t clear from standard factors like cholesterol, blood pressure, or family history.
It provides a clearer picture in that:
• A score of 0 means very low short-term risk, which may help avoid unnecessary treatments.
• A positive score confirms atherosclerosis, signaling the need for lifestyle changes or medications like statins.
Who most benefits from a coronary calcium scan?
The CAC test is most helpful for people who are not clearly at low or high risk of heart disease but want to better understand their heart health. Specifically:
1. People with Risk Factors for Heart Disease. If you have factors like high cholesterol, high blood pressure, diabetes, or a family history of heart disease, but no clear signs of a problem, the test can show whether plaque is starting to build up in your arteries.
2. People Who Aren’t Sure About Taking Medications. If you’re on the fence about starting cholesterol-lowering medications like statins, a calcium score can help clarify if you truly need them. A score of 0 may mean you can hold off, while a positive score shows a need for action.
3. Middle-Aged Adults (40s–60s). This group often benefits the most, especially if they don’t have symptoms but want to check for hidden heart disease.
4. Younger Adults with Strong Family Histories. If close family members developed heart disease at a young age, this test can help detect early signs of plaque buildup even in your 30s or 40s.
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When do doctors typically prescribe a coronary calcium scan?
• Intermediate Risk Patients: When traditional risk assessments (e.g., ASCVD risk calculator) yield uncertainty about whether to initiate therapies like statins.
• Borderline Risk Patients: To reclassify risk and guide preventive measures.
• Family History of Heart Disease: In asymptomatic individuals with a strong family history of premature CAD.
• Symptomatic Patients: Occasionally used for mild or ambiguous symptoms to assess underlying risk.
If close family members developed heart disease at a young age, this test can help detect early signs of plaque buildup even in your 30s or 40s.
What are the risks of a coronary calcium scan?
• Radiation Exposure: Low dose, comparable to mammograms (~1 mSv), but may accumulate with repeated tests.
• False Reassurance: A score of 0 may miss soft or non-calcified plaques.
What is the cost of a coronary calcium scan?
• Range: Typically, $100 to $400, depending on the healthcare facility and region.
• Affordable: It is one of the less expensive imaging tests compared to other cardiovascular imaging modalities.
Who pays for a coronary calcium scan?
• Insurance: In the U.S., most health insurance plans do not routinely cover CAC scoring, as it is considered a preventive test.
• Out-of-Pocket: Patients often pay for it themselves. Some hospitals offer it as a cash-pay service at discounted rates for preventive screening.
• Medicare: Generally, does not cover the test unless explicitly deemed medically necessary.
Conclusion
While the CAC test offers valuable risk assessment capabilities at a relatively low cost ($100-400) and minimal radiation exposure, it has important limitations—it cannot detect non-calcified plaque and up to one-third of cardiac events occur in people with zero calcium scores. Despite inconsistent insurance coverage, the test remains a useful tool for middle-aged adults and those with family histories of heart disease who need clearer guidance on their cardiovascular risk and treatment decisions.