A zero on this test is great news for your heart

Posted by Al Boyle
On January 14, 2024

“Mr. Blutarsky… zero… point… zero.”


Faber College Dean Vernon Wormer, stating Bluto’s grade point average with disgust
Animal House (1978)

Ever learn something that stuns you?

I learn a lot from researching this newsletter. Science keeps finding ways to surprise me.

The surprise was relative to atherosclerosis, which The Cleveland Clinic defines as a hardening of your arteries due to gradual plaque buildup.

You may be more familiar with the term coronary artery disease (CAD). Well, here’s the part from Doctor Peter Attia’s blog that stunned me (bolding mine):

“…it’s a disease that takes a long time to evolve, starting in the first two decades of life.That’s right, the process begins almost as soon as you’re born.”

Sobering, when I consider I spent my first two decades thinking about girls, movies & television, girls, sports, girls, getting through school, and did I mention girls?

Heart health wasn’t on my mind. I was young and “invincible.” Those in my orbit with heart problems were… old(er).

Little did I know, some seed-sowing could be underway. Or not. Genetics, nutrition, exercise, and environment are the usual suspects impacting your risk level.

The good news is, if your doctor believes you’re at risk, they can have you tested for it.

How calcified plaques end up in your arterial wall

“The greatest trick the Devil ever pulled was convincing the world he didn’t exist.”


Verbal Kint
The Usual Suspects (1995)

Your body produces the plaques in self-defense, trying to contain the sludgy mix of lipids, cholesterol, and other cellular materials entering your arterial wall.

That’s right: This goo lurks deep within you, slowly progressing until it narrows, erodes, or ruptures, causing blood-related clinical events such as fatal or non-fatal heart attack or stroke.

I find Peter Attia’s analogy super helpful for not only understanding what the test means, but its limitations:

“When I talk about CAC, I often use an analogy of atherosclerosis as a crime scene involving breaking, entering, and vandalizing. A criminal went into your house while you were on vacation and did some damage to your home, damage that was somewhat irreparable in that you couldn’t repair your home back to a state where you never would’ve known there was a break-in. Holes in the walls of your home needed to spackle to patch them up. The repair work left clues of damage. In the case of atherosclerosis, a lesion is a damaged artery, and the calcium deposits are a sign of repair to the artery.

A CAC score above zero tells you that there’s been a bad enough break-in to require repair. However, a lot can go on in the disease process leading up to that point that goes unnoticed by a CAC scan. Additionally, a CAC scan does not necessarily identify the plaques that might do the most damage.”

Still, identifying something is better than nothing. But how do you do that if you can’t see it, hear it, or feel it?

“No problemo.”


The T-100, responding to John Connor’s delight with his instantly learning slang.
Terminator 2: Judgment Day (1991)

Coronary artery calcium (CAC) scan

“Houston, we have a problem.”


Astronaut Jim Lovell, radioing Houston regarding the dire nature of their circumstances post-oxygen tank explosion
Apollo 13 (1995)

A coronary artery calcium (CAC) scan is a non-invasive CT scan that measures the calcium in your coronary arteries to help determine your heart attack or stroke risk.

The score, measured in Agatston Units, ranges from 0 to 400. And as Peter Attia mentioned in the quote above, anything above zero indicates calcified plaque is present in your arterial walls.

The higher the score, the more deposits. This increases your atherosclerotic cardiovascular disease (ASCVD) event risk, suggesting coronary artery disease.

Consider this from another perspective…

When you go for your dental exam, the hygienist scrapes plaque buildup off of your teeth.

Imagine that gunk anywhere near your heart. Disturbing.

The scan can give you an idea how much buildup you do or don’t have.

“Hello, Houston. This is Odyssey. It’s good to see you again.”


Jim Lovell to mission control after the Odyssey re-emerges from blackout
Apollo 13 (1995)

How the CAC scan works

The CAC scan provides coronary artery images showing calcium deposits.

It’s a painless (if you don’t have a hairy chest), non-invasive, 15-minute procedure. You lie on a table, they apply sticky pads to your chest, then slide you into the CT scanner up to your chest.

Insurance coverage

Some insurance companies may not cover the scan. If you’re paying for it, expect an out-of-pocket cost between $100-400.

Sure hope the insurance industry decides to underwrite the modest upfront investment. Can’t imagine it not saving countless lives and enough cash to blow a billionaire’s mind.

Who is the scan not recommended for?

Doctors don’t recommend the test for:

  • Pregnant individuals due to the potential harm to the fetus from the CT scan
  • Routine screening for those without symptoms for heart disease

Heart to heart

Despite advances in medical science, heart disease remains a leading cause of death worldwide. I don’t know how many could be prevented with proper care and lifestyle changes.

I do know healthcare professionals advocate for proper care and lifestyle changes with such frequency too many people have long since tuned them out… until it’s too late.

But that’s not you. You’re proactive, or at last diligent in your responsiveness.

You’re in it for the long haul.

And while the CAC scan isn’t perfect, it still provides critical insights that could save lives.

I hope you never need it.

And I hope it brings you good news if you do.

Take care.




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