28/07/2026
🫀 CORONARY ARTERY CALCIUM (CAC) SCORE
CAC scoring is a quick, non-contrast CT scan that measures calcified coronary plaque and helps refine cardiovascular risk in asymptomatic patients.
🟦 WHAT DOES THE SCORE MEAN?
• CAC 0: No detectable calcified plaque
• CAC 1–99: Mild plaque burden
• CAC 100–299: Moderate plaque burden
• CAC 300–999: Severe plaque burden
• CAC ≥1000: Extensive disease and very high cardiovascular risk
CAC reflects the total burden of coronary atherosclerosis but does not reliably indicate stenosis severity.
🟦 WHO SHOULD GET CAC SCORING?
✅ Asymptomatic adults with borderline or intermediate ASCVD risk when the decision to start a statin is uncertain.
✅ Patients hesitant to start lipid-lowering therapy who want a more personalised risk assessment.
🔴 WHEN IS CAC SCORING NOT RECOMMENDED?
❌ Established ASCVD
❌ LDL-C ≥190 mg/dL
❌ Clear indication for statin therapy
❌ Symptoms suggestive of myocardial ischaemia (use appropriate diagnostic testing instead)
❌ Moderate or severe CAC already identified on another chest CT
🟢 CAC = 0 ("THE POWER OF ZERO")
Usually supports deferring statin therapy because cardiovascular risk is very low.
Exceptions:
• Diabetes
• Current smoker
• LDL-C ≥190 mg/dL
• Familial hypercholesterolaemia
• Strong family history of premature ASCVD
📌 Consider repeating CAC in 3–7 years only if the result would change management.
🟦 CAC 1–99
✅ Statin therapy is reasonable, especially if CAC is >75th percentile for age, s*x and ethnicity.
Shared decision-making is recommended.
🔴 CAC ≥100 OR ≥75TH PERCENTILE
✅ Statin therapy is generally indicated.
LDL-C Targets:
• CAC 100–299:
