Cardiovascular disease remains the leading cause of death in the United States, yet many at-risk patients go undiagnosed until the disease has progressed. Traditional risk calculators, while useful, can sometimes overestimate or underestimate risk, leaving both doctors and patients uncertain about the right next step.
That’s where calcium scoring can add clarity. By identifying plaque in the coronary arteries early, calcium scoring allows doctors to assess risk and guide care more accurately. This can mean avoiding unnecessary medication for some patients while helping others begin evidence-based therapies before a cardiac event occurs.
Nebraska Medicine cardiologist Ward Chambers, MD, explains how calcium scoring works, when it can be helpful and how artificial intelligence is expanding the role of calcium scoring in clinical practice.
What calcium scoring measures
A cardiac calcium score CT quantifies calcified plaque in the coronary arteries. The non-contrast scan takes only a few minutes, requires no IV and uses very low radiation exposure.
Results are reported as both:
- Absolute calcium score.
- Percentile risk based on patient’s age and sex.
Together, these metrics help determine cardiovascular risk and guide next steps, including whether to initiate statin therapy or pursue additional testing.
How AI is expanding the role of calcium scoring
Traditionally, calcium scoring required dedicated cardiac imaging. With AI, scoring can now be performed on routine CT scans — even those done for non-cardiac indications such as lung cancer screening. Nebraska Medicine is currently negotiating the adoption of this AI technology, with plans to use it to identify patients with cardiovascular disease risk earlier.
“Around 20-35% of patients with significant blockage have either no symptoms or atypical symptoms,” Dr. Chambers explains. “Being able to screen opportunistically gives us a powerful new way to detect risk and intervene sooner.”
Coverage and referrals
Insurance coverage varies, but many plans recognize the value of calcium scoring and will cover the test. If coverage is denied, Nebraska Medicine offers a cash-pay option of $150, making it an affordable tool for most patients.
Referrals are simple: send patients directly to radiology. Both radiologists and cardiologists review each scan, ensuring accuracy in the calcium score and flagging any incidental findings. This collaborative approach provides a more complete picture to help guide follow-up care.
Candidates for calcium scoring
Calcium scoring is most valuable in middle-aged and older adults, when calcified plaque is more predictive. It is generally not recommended before age 40, as younger patients often have non-calcified plaque that may not register. It is also less useful in those already at established high risk, such as diabetics, smokers, patients with very high cholesterol or those already on statins.
Patients who may benefit include:
- Adults with borderline or intermediate atherosclerotic cardiovascular disease risk scores.
- Individuals for whom the decision to start statins is uncertain.
- Patients seeking a more individualized understanding of their cardiovascular risk.
Interpreting calcium scoring results
Calcium scores are reported in ranges that align with treatment guidelines, making it easier to decide the next step in management:
- 0–100: Low risk — Most patients can be managed with lifestyle interventions and reassurance.
- 100–400: Moderate risk — Often prompts shared decision-making about starting statins or other preventive therapies.
- 400+: High risk — Patients at this level usually benefit from lipid-lowering therapy, additional diagnostic testing and closer follow-up.
In practice, the calcium score provides a concrete framework for clinical decision-making. A patient with an intermediate risk score on paper but a calcium score of zero may safely avoid medications, while another patient with a higher score can be guided toward early intervention that prevents a future cardiac event.
A proven tool with growing potential
Calcium scoring has been validated for more than 25 years, with landmark studies like MESA confirming its predictive value. Building on that research, the MESA app can now be downloaded to a smart device to calculate risk using an individual’s calcium score. The addition of AI may make calcium scoring even more accessible and impactful.
“Calcium scoring is inexpensive by today’s standards and gives us information we simply didn’t have before,” Dr. Chambers says. “It allows us to individualize cardiovascular prevention in a way that’s both evidence-based and patient-specific.”