Heart Health

Calcium score 0, with a risk enhancer

Coronary artery calcium (CAC) score? (further testing beyond basic labs) 0, but risk-enhancing factors present

Recommendationcac-zero-highriskNo one has reached this rule yet

Statin still on the table — a CAC scan can't see Lp(a)

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.

  • Reasonable — worth discussing

    Even with a CAC score of 0, a statin is still on the table because of your risk-enhancing factors.

    The guideline's CAC-based deferral only applies when no risk enhancers are present — you have at least one, so a CAC of 0 doesn't settle the decision by itself. Elevated Lp(a), in particular, is not something a CAC scan can see.

    2026 ACC/AHA/Multisociety Guideline on the Management of Dyslipidemia · Class 2a/2b

An example person who reaches it

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

57-year-old manBP 128/80LDL 138Lp(a) 160 mg/dLcalcium score 010-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)One or more present
  4. Coronary artery calcium (CAC) score? (further testing beyond basic labs)0, but risk-enhancing factors present ← 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.

What we are least sure of here

  • Q6Is the major / standard / provisional weighting of risk enhancers the right shape, and are the assignments right?

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Runs in lib/engine/lipidPathway.ts as cac-zero-highrisk.