09/08/2026
• Dr. Carrie Lam | Root Cause and Functional MD
He had a coronary calcium score of ZERO — and still had a heart attack. 👇
I’ve seen it over and over, and it’s more common than anyone tells you. Here’s why it happens:
A calcium score only sees plaque that’s already hardened. But the plaque that actually ruptures and causes a heart attack is soft plaque — unstable, dangerous, and invisible on a calcium scan.
So a score of zero doesn’t mean you’re clear. It just means the plaque hasn’t calcified yet.
Here’s what we look at instead:
🫀 A CT coronary angiogram — an advanced, non-invasive heart scan that uses AI to map your arteries in detail and actually spot the soft plaque a calcium score misses.
Plus 4 blood markers most standard panels skip:
🔴 ApoB — the number of plaque-forming particles; a far better predictor than LDL alone.
🧬 Lp(a) — a genetic risk factor affecting 1 in 5 people that almost nobody gets tested for.
🔥 hs-CRP — inflammation, where soft plaque rupture begins.
⚠️ Lp-PLA2 — flags the unstable plaque most likely to break off.
None of this is experimental — these are evidence-based markers that just aren’t on a standard panel.
So if you’ve got a “zero” calcium score but a high ApoB or elevated Lp(a), soft plaque may be building silently right now. A clean calcium scan is not the same as a healthy heart.