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.

    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.

    2026 ACC/AHA/Multisociety Guideline on the Management of Dyslipidemia · Test — would change the decision

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 deciding who gets a statin by coronary calcium score, instead of the standard risk-factor calculator, change how many people have a heart attack or stroke?

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.