Coronary Artery Calcium Score (CAC)

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Coronary Artery Calcium (CAC) scoreCoronary Artery Calcium Score (CAC)

Prevention is a primary focus at our Tulsa Integrative Medicine clinic. Unfortunately, the first symptom of a heart attack, for most people, is… a heart attack. The Coronary Artery Calcium Score (CAC) is an important test that helps detect cardiovascular disease much earlier than most common cardiovascular tests.

My traditional medical training taught me to work up cardiovascular disease as follows: If the patient isn’t having active chest pain or shortness of breath with exertion then my tests included a standard lipid (cholesterol) panel, A1c and blood sugar, blood pressure, and maybe an EKG. If those tests were normal then we were basically done.

As I’ve stated many times, this approach misses 50% of people who will have a heart attack.1

It is essential that we are more aggressive in looking for cardiovascular disease BEFORE there is advanced disease. We have to be much more comprehensive in our testing and screening. Tests such as EndoPAT, Endothelix, CIMT, CV Profiler, and many others are much more sensitive for detecting cardiovascular disease in its very early stages where it is much easier and more cost effective to treat.

In talking about the traditional approach to cardiovascular disease, if a patient does have chest pain, shortness of breath, or any other symptom of cardiovascular disease then a stress test is often ordered, which is very appropriate by the way. However, these stress tests are often not positive until there is at least 60-70% blockage of the coronary artery. The most interesting thing to me is that 68% of heart attacks occur in arteries with less than 50% blockage.2


National guidelines recommend the use of population-based risk algorithms, such as the Pooled Cohort Risk Assessment Equations, to determine atherosclerotic cardiovascular risk (ASCVD). “These risk algorithms are remarkably effective in predicting risk in populations, but have limitations in predicting individual risk,” says R Todd Hurst, M.D., director of the Heart Health and Performance Program at Mayo Clinic’s campus in Phoenix/Scottsdale, Arizona. “The best illustration of these limitations is that the majority of CVD events (up to 75 percent) occur in low- and intermediate-risk populations.”


  1. Circulation. 1995;92:657–671