Heart disease remains the leading cause of death for women in the United States, often progressing silently and without warning signs. One of the tools used to detect early heart disease is the coronary artery calcium (CAC) scan, a non-invasive imaging test that measures calcium buildup in the coronary arteries. While this test has become a cornerstone in cardiovascular prevention, recent insights show that a zero CAC score in women may not always guarantee low risk.
What Is a Coronary Artery Calcium Scan?
A CAC scan uses computed tomography (CT) to detect and quantify calcium deposits in the coronary arteries. Calcium buildup is a marker of atherosclerosis, a condition in which plaque accumulates in the arterial walls. A CAC scan generates a calcium score, with higher numbers indicating greater coronary plaque burden and increased risk of heart attack. Traditionally, a score of zero has been interpreted as very low risk for coronary heart disease.
Limitations of CAC Scoring in Women
Recent research highlights a significant limitation: women with a zero CAC score may still face meaningful risk for heart disease, particularly if other risk factors are present. Conditions such as high blood pressure, diabetes, high cholesterol, or a family history of heart disease can elevate risk even when no calcium is detected.
Moreover, women often develop coronary artery disease later than men, usually post-menopause, which can delay detection. Additionally, symptoms in women can differ from the classic chest pain presentation. Women may experience fatigue, shortness of breath, nausea, or other subtle symptoms, sometimes resulting in misdiagnosis or delayed intervention.
Women with detectable calcium, even at low levels, may have a considerably higher risk than previously thought. Studies indicate that low-risk women with CAC scores above zero have a significantly elevated chance of cardiovascular events compared with women with no detectable calcium.
Why Early Detection Matters
Early identification of coronary artery disease is critical. For women, especially those with risk factors but no symptoms, CAC scanning can uncover hidden risks that traditional assessments might miss. A higher calcium score can prompt proactive measures, including lifestyle modifications or preventive medication, helping reduce the likelihood of serious cardiovascular events.
Takeaway
While CAC scans are a valuable tool for assessing heart disease risk, it is important to understand their limitations, especially for women. A zero score should not be taken as a guarantee of heart health. Women should work closely with healthcare providers to evaluate overall cardiovascular risk, considering all factors—including CAC scores—to develop a comprehensive prevention plan.
For more in-depth insights, read the original article by Dr. Peter Attia: When Zero Doesn’t Mean Zero: The Limits of Coronary Calcium in Women.
