Coronary Calcium Score: The $100 Test That Predicts Heart Attacks

What it is

What a Coronary Calcium Score Measures

Atherosclerotic plaque inside the coronary arteries calcifies as it matures. A non-contrast CT of the chest, gated to the cardiac cycle, can quantify that calcium and assign an Agatston score — a number from 0 to several thousand.

0 means no detectable calcified plaque. 1–99 is mild, 100–399 moderate, 400+ severe. The score is reported alongside age- and sex-matched percentiles.

The scan takes about 10 minutes, requires no contrast, no IV, no fasting, and delivers radiation similar to a mammogram (~1 mSv).

Why it matters

Why Cardiologists Take CAC Seriously

CAC outperforms traditional risk calculators (ASCVD, Framingham) for personalizing cardiovascular risk in the intermediate-risk patient — exactly the patient most likely to be on the fence about a statin.

The MESA cohort and large registry data are consistent: CAC of 0 in an asymptomatic adult predicts roughly a 1–2% 10-year event risk regardless of cholesterol numbers. CAC >100 roughly doubles event risk vs. CAC 0 even when LDL is identical. CAC >400 puts you in a high-risk category that nearly always merits aggressive lipid lowering.

AHA/ACC guidelines explicitly endorse CAC as a tiebreaker for statin decisions in borderline and intermediate-risk adults.

Who should get one

Who Should Get a CAC — and When

Reasonable candidates: men 40+ and women 45+ without known coronary disease, particularly anyone with elevated ApoB or Lp(a), family history of premature CAD, diabetes, hypertension, or a borderline statin decision.

Less useful: adults under 35 (calcified plaque rarely accumulates that young — non-calcified soft plaque can be missed). Adults already on guideline-directed statin therapy with known disease (the score won't change management).

Frequency: a CAC of 0 in an otherwise low-risk adult can be reasonably re-checked in 5–10 years. A non-zero score generally doesn't need repeating — the absolute number will keep rising on a statin even as risk falls.

Cost

What CAC Costs in 2026

Cash price: typically $75–$400 in the U.S. Hospital imaging centers run higher ($200–$400); standalone outpatient CT centers and concierge longevity programs often run $99–$150.

Insurance coverage is inconsistent — many plans still classify CAC as screening and don't cover it, though that's slowly changing. Texas and a few other states have laws mandating coverage for selected populations.

Pricing reviewed June 2026.

Limits

What CAC Doesn't Tell You

CAC measures calcified plaque only. Soft, non-calcified plaque — the kind that ruptures and causes most heart attacks — is invisible on CAC. A score of 0 in a 35-year-old with elevated Lp(a) and ApoB is reassuring but not definitive.

CAC also does not assess flow-limiting stenosis. A high CAC tells you disease exists; it does not tell you whether you're about to have symptoms. That's what stress testing or CT coronary angiography (CCTA) is for.