Heart Health

Calcium score not measured

Coronary artery calcium (CAC) score? (further testing beyond basic labs) Not measured

Testcac-unknownNo one has reached this rule yet

Offered when the decision is still open (borderline or intermediate risk, men ≥40 / women ≥45, or below 3% with a major enhancer)

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.

  • A test worth considering

    A coronary calcium scan — ordered as "CT calcium scoring, heart, without contrast" — would resolve this.

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

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

    Your risk sits in the band where the decision is genuinely open, which is what this scan is for. Once you have a number it also sets the target: any calcium supports an LDL goal of 100, a score of 100 or more supports 70, and above 300 a goal of 55 is an option.

    Where the guidelines stand

    ACC/AHA (US)

    • RecommendsClass 1Level B-R

      Graded for adults at intermediate risk and selected adults at borderline risk when the decision about a statin is uncertain. Below 3% risk the guideline does not grade a scan.

      2026 ACC/AHA/Multisociety Guideline on the Management of Dyslipidemia · Recommendation behind this rule · class and level read from the guideline tables on 2026-09-30

    ESC (Europe)

    • RecommendsClass IIaLevel B

      Subclinical atherosclerosis or a raised calcium score should be considered 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-R

An example person who reaches it

“Borderline risk + high Lp(a)” — an illustrative profile, not a real user.

58-year-old manBP 132/82LDL 140Lp(a) 78 mg/dL10-yr PREVENT-ASCVD 4.9%

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)One or more present
  4. Coronary artery calcium (CAC) score? (further testing beyond basic labs)Not measured ← this rule
  5. hs-CRP ≥2 mg/L, confirmed on a repeat test? (further testing beyond basic labs)Not measured

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.

  • CorCal Outcomes — Does choosing who gets a statin by calcium score, instead of the usual risk calculator, prevent more heart attacks and strokes?

What we are least sure of here

  • Q19Should test verdicts be framed as 'what decision would this change?' rather than 'worth doing'?

Review this rule

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