Heart Health

Calcium score 0, no risk enhancers

Coronary artery calcium (CAC) score? (further testing beyond basic labs) 0, and no risk-enhancing factors

Recommendationcac-zero-lowriskNo one has reached this rule yet

Reasonable to defer statin; reassess CAC in 3–7 years

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 to do

    It's reasonable to defer statin therapy and reassess with a repeat scan in 3-7 years.

    Your CAC score is 0 with no risk-enhancing factors on record, which is associated with a low near-term event rate. Two caveats: a zero means no *calcified* plaque, not no plaque, and it is least reassuring under about 45, the exact age band PESA studied directly. PESA, a Spanish cohort of 4,002 people with no heart disease, found that 63% already had atherosclerosis somewhere in their arteries on ultrasound, but only 18% had any coronary calcium. Most disease this early hasn't calcified yet.

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

An example person who reaches it

“Borderline risk, calcium score of zero” — an illustrative profile, not a real user.

57-year-old manBP 128/80LDL 138calcium score 0hs-CRP 1.110-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)0, and no risk-enhancing factors ← this rule
  5. hs-CRP ≥2 mg/L, confirmed on a repeat test? (further testing beyond basic labs)No

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.

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