Coronary Artery Calcium Score: the "Mammogram" of the Heart?

“A mammogram for the heart” is a compelling pitch for coronary calcium scoring — a simple, low-dose scan to catch silent disease early. This review takes the analogy seriously and asks whether it holds up.

The verdict is a careful yes-and-no. As a tool for refining risk in people already under evaluation, CAC is robust — few markers add as much. But the mammogram framing implies population screening, and there the evidence thins: no outcome trial has shown that scanning all asymptomatic adults and acting on the results reduces events the way breast-cancer screening does.

The practical takeaway is to use CAC where it has earned its evidence — sharpening treatment decisions in selected, intermediate-risk people — without overselling it as a universal screen. The resistance runs through guideline committees and insurers wary of endorsing broad screening without outcome data and with real cost attached.

We rate the evidence moderate: a balanced 54-reference narrative review, not new data. Its clinical significance is moderate and largely communicative — the mammogram analogy is genuinely useful for explaining CAC to patients — but the review’s own conclusion, that universal screening isn’t yet justified, caps its immediate effect on practice.