Written by Arvind Srivastav
Published
A calcium score is a quick 10 minute CT scan that looks for calcified plaque in your heart arteries. It's also called a CAC score. It's more useful than blood tests and a 0 score is usually reassuring, especially for people over 55. However, it does not prove your arteries are completely plaque-free because the scan can miss the crucial soft plaque.
What does a calcium score show?
The vast majority of heart problems arise from plaque buildup in our arteries. It can happen due to a lot of factors and they are not fully captured by a blood test.
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, resulting in calcified plaque.
A calcium score is a simple CT scan-based test that captures this calcified plaque. So a positive score means plaque is present in the heart arteries.
This test is very affordable. It costs less than $200. If you have a positive calcium score, it's time to start working on your heart health.
What does a calcium score miss?
A calcium score misses the soft plaque. This is especially important in younger people, whose plaque is less likely to be calcified. Studies show calcium score underestimates risk in:
- Men under 40 and women under 55
- South Asians due to genetics
- People with high Lp(a)
In addition, there are three major 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 far more important. Soft plaque is more prone to rupture and cause a heart attack. Calcium scores miss it entirely.
This is where a coronary CT angiogram is a much better scan. It gives you the full picture of your heart arteries, including calcified and soft plaque, so that you have clarity about your heart health.
What to do with your calcium score results
Recent cholesterol guidance makes calcium score more actionable. It sets 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 very different at 40 than at 60. That's why we've built a research-backed calculator that helps you compare your score to others your age and sex. It helps you see where you stand in the risk profile.
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), a CT angiogram can help you see if you have early soft plaque buildup.
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 but it's not the calcified portion of the plaque that a person has to worry about. In fact, your score may even rise after you start lifestyle changes or statins. It's because statins stabilize the soft plaque into calcified plaque, which is safer.
What you can do is slow or stop the plaque buildup 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
Our advanced heart scan that gives you the full picture of your arteries, giving you clarity and the power to act early.