Heart Health

Calcium score above 0

Coronary artery calcium (CAC) score? (further testing beyond basic labs) Above 0

Recommendationcac-positiveFewer than 5 people have reached this rule so far

Treat now; the score sets the goal — any calcium → LDL <100, ≥100 → <70, ≥300 → <55 optional

Clinical review

All reviewers

No clinician has signed off this rule yet. It reflects our reading of the guidelines cited below, which has not been independently checked.

What someone who reaches this rule is told

Word for word, as generated for the example person below. Figures in the text are theirs.

  • Strongly recommended

    Your CAC score of 140 supports starting lipid-lowering therapy now, aiming for LDL-C below 70 mg/dL (and non-HDL-C below 100).

    Expert guidelinesOfficial guidelines recommend it, based on trials plus expert judgment.

    ACC/AHAClass 1Level B-NRESC/EASClass IIaLevel B
    Why, and the source

    Any coronary calcium at borderline or intermediate risk supports treating rather than waiting, and the score itself sharpens the target: any calcium supports a goal of 100, and 140 being at or above 100 supports 70. One thing to know before any repeat scan: a statin that is working reliably raises this number, because the score weights density and treatment makes plaque denser. A higher score later is not a reason to stop the statin.

    Where the guidelines stand

    ACC/AHA (US)

    ESC (Europe)

    • RecommendsClass IIaLevel B

      Calcium score as a risk modifier near a treatment threshold. The ESC sorts risk with SCORE2, not the PREVENT equations used here, so the tiers line up only roughly.

      2025 ESC/EAS focused update on dyslipidaemias · Recommendation tables · class and level read from the guideline tables on 2026-09-30

    2026 ACC/AHA/Multisociety Guideline on the Management of Dyslipidemia · Class 1 · Level B-NR

An example person who reaches it

“Borderline risk, calcium found, hs-CRP raised” — an illustrative profile, not a real user.

57-year-old manBP 128/80LDL 138calcium score 140hs-CRP 3.210-yr PREVENT-ASCVD 4.0%

Their path through cholesterol

  1. Known ASCVD (prior heart attack, stroke, or revascularization)?No
  2. Your situation (severe hypercholesterolemia short-circuits the risk score)10-yr risk 3–5% (borderline)
  3. A risk-enhancing factor that counts? (weighted — a single unconfirmed hs-CRP does not count until repeated)None on record
  4. Coronary artery calcium (CAC) score? (further testing beyond basic labs)Above 0 ← this rule
  5. hs-CRP ≥2 mg/L, confirmed on a repeat test? (further testing beyond basic labs)Yes

Where it sits

Asked after: Chronic kidney disease, age 40–75, HIV, age 40–75, 10-year risk 5% to under 10%, 10-year risk 3% to under 5%, Low 10-year risk, high lifetime risk, Low risk with a major risk enhancer

Sources

Cited by the recommendations above.

Being tested further

A trial that could change this, still running or reported too recently to be settled.

  • The Optimal Trial — If you have coronary calcium, does adding a CT angiogram (which also shows soft plaque and narrowing) change your care for the better?

What we are least sure of here

  • Q14Is the calcium-paradox warning — statins raise the score — stated strongly enough?

Review this rule

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Runs in lib/engine/lipidPathway.ts as cac-positive.