Alejandro González Veliz: A Coronary Calcium Score of Zero Doesn’t Always Mean Zero Risk
Alejandro González Veliz, Interventional Cardiologist at Institute of Cardiology and Cardiovascular Surgery, shared a post on LinkedIn:
“A Coronary Calcium Score of zero doesn’t always mean zero risk.
For years, we’ve considered a CAC score of 0 as reassuring—and in most cases, it is.
A zero calcium score is associated with a very low risk of cardiovascular events and can help guide preventive therapies.
But here’s the catch:
Calcium is only part of the story.
Some patients, especially:
- Younger adults
- Smokers
- Patients with diabetes
- Those with a strong family history of premature CAD
may still have non-calcified plaques that remain invisible to calcium scoring.
In fact, vulnerable soft plaques can exist despite a CAC equals to 0 and may still lead to acute coronary syndromes.
That doesn’t make calcium scoring a bad test.
Quite the opposite.
It remains one of the most powerful and cost-effective tools for cardiovascular risk stratification and shared decision-making.And the future is even more exciting:
Artificial intelligence is now helping us extract far more information from cardiac CT, including:
- Coronary plaque burden
- Plaque composition
- Epicardial fat
- Pericoronary adipose tissue
- Personalized cardiovascular risk prediction
The goal isn’t simply finding the biggest blockage. It’s identifying risk before symptoms appear. Because prevention begins long before the first plaque ruptures.
What do you think?
Should coronary calcium scoring be used more often in clinical practice?”
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