Your credit score may determine what you can buy. Your coronary calcium score may help determine how long you will be here to enjoy it. -- YNOT!

Most Americans know—or can quickly find—their credit score.

We monitor it because it affects whether we can buy a house, finance a car, obtain a business loan or qualify for a credit card. Financial companies constantly remind us that this three-digit number matters.

But there is another number that may be far more important.

It will not determine whether a bank lends you money. It may help determine whether you live long enough to pay the loan back.

That number is your Coronary Artery Calcium score, commonly called a CAC score.

A credit score estimates how reliably you have handled debt. A coronary calcium score measures evidence of calcified plaque that has accumulated inside the arteries supplying blood to your heart.

One number affects your financial future.

The other may reveal what is happening inside your cardiovascular system—often years before you experience a heart attack.

What Is a Coronary Artery Calcium Score?

A coronary artery calcium test is a specialized CT scan of the heart. It looks for calcium deposits in the walls of the coronary arteries—the blood vessels responsible for supplying oxygen-rich blood to the heart muscle.

The test is generally quick, painless and performed without intravenous contrast. The scan itself usually takes approximately 10 to 15 minutes and exposes the patient to a relatively low dose of radiation.

The result is usually reported as an Agatston score, named after the physician who helped develop the scoring system.

The basic principle is straightforward:

The more coronary calcium detected, the greater the burden of calcified coronary plaque.

Higher CAC scores are generally associated with a higher future risk of coronary heart disease, heart attack and other cardiovascular events.

Why Is This Different From a Cholesterol Test?

A cholesterol test measures risk factors circulating in your blood.

It can tell you your:

• LDL cholesterol
• HDL cholesterol
• Triglycerides
• Total cholesterol

Those numbers are important, but they do not directly tell you how much plaque has already accumulated in your coronary arteries.

A person can have moderately elevated cholesterol and considerable plaque. Another person can have similar cholesterol numbers but very little detectable calcium.

The coronary calcium scan adds another piece of information: it looks for physical evidence that the disease process has already affected the coronary arteries.

In other words, cholesterol testing helps estimate the conditions that can produce atherosclerosis. A CAC scan looks for evidence that calcified atherosclerotic plaque is already present.

However, the test is not perfect. It detects calcified plaque, not every form of plaque. Younger people may have noncalcified or “soft” plaque that does not appear on a calcium scan. A score of zero therefore does not mean that heart disease is impossible.

Understanding the Numbers

CAC results are commonly interpreted approximately as follows:

The exact interpretation depends on more than the raw number. Physicians may also consider your age, sex and the percentile into which your score falls.

For example, a score of 100 may have a different meaning in a 45-year-old than in an 80-year-old. Calcium becomes more common with age, so a younger person with measurable coronary calcium may rank unusually high compared with others of the same age.

That is why a complete CAC report often contains both:

1. Your total Agatston score.
2. Your percentile compared with people of a similar age and sex.

What Does a Score of Zero Mean?

A score of zero is generally reassuring.

It means that the scan did not detect calcified plaque in the coronary arteries. In many asymptomatic adults, that finding is associated with relatively low near-term cardiovascular risk.

In the Multi-Ethnic Study of Atherosclerosis, commonly known as MESA, 10-year cardiovascular event rates among people with a CAC score of zero ranged from approximately 1.3% to 5.6% across different demographic groups. By comparison, people with CAC scores above 300 had 10-year event rates ranging from approximately 13.1% to 25.6%.

That is an enormous difference.

But zero does not mean immortal, bulletproof or permanently protected.

A zero score does not exclude:

• Noncalcified plaque
• Future plaque development
• High blood pressure
• Diabetes
• Smoking-related cardiovascular damage
• Genetic cholesterol disorders
• Dangerous symptoms requiring immediate evaluation

A calcium score is a snapshot taken at one point in time. It is not a lifetime guarantee.

Certain people with a score of zero may still need cholesterol-lowering treatment, particularly those with diabetes, cigarette use, very high LDL cholesterol or a strong family history of premature coronary disease.

What Does a Score Above Zero Mean?

Any score above zero means that calcified coronary plaque was detected.

That matters because coronary plaque does not belong in healthy arteries.

A score between 1 and 99 generally indicates a relatively mild plaque burden, but it still confirms that the atherosclerotic process has begun.

A score of 100 or more carries considerably greater significance. American College of Cardiology guidance has treated a CAC score of at least 100—or a score at or above the 75th percentile for age and sex—as strong evidence supporting statin treatment in appropriate patients.

The updated 2026 ACC/AHA cholesterol guidance states that the presence of any coronary calcium supports an LDL cholesterol goal below 100 mg/dL, with progressively lower LDL targets appropriate as the amount of coronary calcium increases.

A high score does not necessarily tell you that a particular artery is 70% or 90% blocked. The CAC test measures calcified plaque burden; it does not directly measure the percentage of narrowing or prove that blood flow is being obstructed.

Nevertheless, a high score is a warning that coronary atherosclerosis is extensive and should not be ignored.

Why This Number May Be More Important Than Your Credit Score

Your credit score can fall, and you can rebuild it.

You can pay down debt, correct errors, establish a longer payment history and gradually improve your financial standing.

Plaque inside your coronary arteries is different.

You may be able to stabilize it, slow its progression and substantially reduce your cardiovascular risk. But you cannot treat a condition you do not know exists.

Coronary artery disease is often silent. A person may feel healthy, work every day, exercise occasionally and have no obvious warning that plaque has been accumulating for decades.

For some people, the first unmistakable indication of coronary artery disease is a heart attack.

That is why the CAC score can be so powerful. It can transform an abstract conversation about risk into visible evidence.

Instead of hearing:

“Your cholesterol is somewhat high, and you may have an elevated risk.”

You may learn:

“There is measurable plaque in the arteries supplying your heart.”

Those are very different conversations.

One describes statistical probability.

The other provides evidence that the disease process is already present.

Who Should Discuss the Test With a Doctor?

CAC testing is primarily used in people who do not have symptoms but whose cardiovascular risk or treatment decision remains uncertain.

The 2026 ACC/AHA cholesterol guidance recommends considering selective CAC testing in men age 40 and older and women age 45 and older who have borderline or intermediate cardiovascular risk when the result would help determine whether cholesterol-lowering treatment should be started or intensified.

The test may be especially useful when someone:

• Has elevated LDL cholesterol
• Has high blood pressure
• Has a family history of premature heart disease
• Is unsure about beginning statin therapy
• Previously stopped a statin because of side effects
• Has several moderate risk factors but no known coronary disease
• Wants a clearer assessment of personal cardiovascular risk

The test is generally less useful when the answer would not change treatment.

For example, someone who has already suffered a heart attack, received a coronary stent, undergone bypass surgery or been diagnosed with coronary artery disease already has established disease. That person usually requires active risk-reduction treatment regardless of the calcium score.

The test is also not intended to evaluate active chest pain or other possible heart-attack symptoms. People experiencing chest pressure, shortness of breath, pain radiating into the arm or jaw, sweating, nausea or other concerning symptoms need prompt medical evaluation—not a routine screening scan.

What Should You Do With the Result?

The calcium score should not be treated as an isolated number.

It should be considered alongside:

• LDL and non-HDL cholesterol
• Blood pressure
• Blood sugar and diabetes status
• Smoking history
• Family history
• Age and sex
• Kidney function
• Body weight and waist circumference
• Exercise habits
• Diet
• Lipoprotein(a), when appropriate
• Apolipoprotein B, when appropriate

Depending on the complete risk profile, a clinician may recommend more aggressive attention to cholesterol, blood pressure, weight, nutrition, exercise, diabetes control or smoking cessation.

Medication decisions should be individualized. No one should begin aspirin, discontinue medication or change a statin dose solely on the basis of an online score chart. Aspirin, in particular, can cause serious bleeding and requires an assessment of both cardiovascular benefit and bleeding risk.

The Test Has Limitations

A coronary calcium scan can provide valuable information, but it is not a universal screening test for every adult.

Potential limitations include:

• Exposure to a small amount of radiation
• Incidental findings that may lead to additional testing
• Failure to detect noncalcified plaque
• Anxiety caused by an abnormal result
• Additional medical costs
• Treatment decisions that may not be appropriate without considering the complete clinical picture

The U.S. Preventive Services Task Force has concluded that evidence remains insufficient to recommend adding CAC testing routinely to traditional cardiovascular risk assessment for every asymptomatic adult. Other professional organizations support selective use when the result is likely to change a prevention decision.

That distinction is important.

The question is not simply:

“Can I get this test?”

The better question is:

“Would knowing my score change what my doctor and I decide to do?”

Know the Numbers That Can Keep You Alive

We have been trained to know our credit score.

Perhaps we should become equally familiar with:

• Our blood pressure
• Our LDL cholesterol
• Our blood sugar
• Our kidney function
• Our waist measurement
• Our family history
• And, when medically appropriate, our coronary artery calcium score

Your credit report tells a bank how you handled yesterday’s debts.

Your coronary calcium score may tell you how decades of genetics, blood pressure, cholesterol, smoking, diet, metabolism and aging have affected the arteries supplying your heart.

One number may help you obtain a mortgage.

The other may motivate you to make the changes necessary to be alive when the mortgage is finally paid.

So ask yourself:

Do you know your coronary artery calcium score?

More importantly:

Should you?

That is a conversation worth having with your physician.

This article is intended for general education and does not replace individual medical evaluation, diagnosis or treatment. Anyone experiencing chest pain, breathing difficulty or other possible symptoms of a heart attack should seek emergency medical assistance immediately.