A calcium score is a quick 10 minute CT scan that answers the question: do you have calcified plaque in your heart arteries? It's more useful than blood tests and a zero is reassuring for most people over 55. But here's what most people don't know: it misses the soft plaque, which is the most important part.
Why is this test needed?
The vast majority of heart issues arise from plaque buildup in our arteries. It can happen due to a myriad of reasons, which are not fully captured by blood tests. Moreover, plaque builds up over time and any blood test only tells you what's flowing in your blood today. It doesn't tell you how your artery health has changed over time.
All plaque buildup starts as soft plaque due to deposition of cholesterol particles in the arteries. Soft plaque is generally less stable. It can rupture and block the arteries, which causes a heart attack. Over time, some of this soft plaque stabilizes. It hardens and becomes calcified.
A calcium score is a simple CT scan-based test that captures this solidified plaque. So a positive score is indicative of plaque presence in arteries.
One reason this test is helpful is that it's very affordable. It costs less than $200. If you find a positive calcium score, it's time to start working on your heart health.
Where does this test fail?
In older people, calcium score is more reliable since more of their plaque has calcified. In younger people, plaque may not have had time to calcify. Studies show calcium score underestimates risk in:
- Under 40 (men) or under 55 (women)
- South Asian
- High Lp(a)
In addition, there are three more problems with calcium score:
- It's only 20% of total plaque volume. Calcified plaque is typically 10–20% of total volume in younger patients. A vast majority is soft plaque which isn't captured by calcium scan.
- Calcium score increases with treatment. Lifestyle improvements and medications stabilize soft plaque by hardening it, leading to higher calcium score in future, even though your heart health is improving.
- Soft plaque is the main problem. Soft plaque is what ruptures and leads to a heart attack. Calcium scores miss it entirely.
This is where a coronary CT angiogram shines. It gives you the full picture of your heart arteries, including calcified and soft plaque, so that you have clarity and peace of mind.
What to do with your calcium score results
The 2026 American Heart Association guidelines make calcium score more actionable. They set LDL cholesterol targets based on your calcium score. Here is the chart.
Calcium score chart and 2026 LDL targets
| Calcium score (Agatston) | What it means | LDL target |
|---|---|---|
| 0 | No detectable calcified plaque. Very low near-term risk. | Standard prevention guidance |
| 1–99 | Mild plaque. Real, but early. | < 100 mg/dL |
| 100–299 | Moderate plaque. Treatment becomes more important. | < 70 mg/dL |
| 300–999 | Significant plaque. Aggressive treatment is recommended. | < 70 mg/dL (aim < 55) |
| 1000+ | Extensive plaque. | < 55 mg/dL |
These are from guidelines. Your doctor may adjust your targets based on your full health history.
Is your calcium score normal for your age?
A score of 50 means something different at 40 than at 60. That's why we've built a research-backed calcium percentile calculator that helps you compare your score to others your age and sex. Use it to see where you stand.
What does a calcium score of 0 mean?
For most people over 55, a zero means you can likely hold off on a statin and recheck in a few years. If you're younger, South Asian, or have high Lp(a), consider a CT angiogram to check for soft plaque. If you're diabetic, a smoker, or have strong family history, guidelines recommend treatment regardless.
What does a high calcium score mean?
Any positive score means plaque is present. Follow the LDL targets in the table above, keep blood pressure below 130/80, and work on lifestyle. If your score is very high (300+), ask your doctor about a CT angiogram to assess soft plaque and narrowing.
Can you lower your calcium score?
Calcified plaque does not go away. Your score may even rise after you start lifestyle changes or statins. It's because statins harden soft plaque into stable, calcified plaque, which is safer.
What you can do is slow progression. Healthier diet, lower LDL, improved blood pressure, exercise, sleep. They all help.
If you want to get full clarity into your heart health, consider our CT angiogram heart scan.
Confidence in your heart health
A CT angiogram heart scan that gives you the full picture of your arteries, giving you clarity and the power to act early. Reserve your spot today.