When to advance from CAC to CT angiography

Heart disease risk isn’t just about cholesterol. In this episode of A Whole New Level, Dr. Matthew Budoff explains why coronary artery calcium (CAC) scoring may be the most important test most people aren’t getting—and why imaging your arteries directly can reveal risk that blood tests alone can miss.

Drawing on decades of research and data from the landmark MESA study, Dr. Budoff explains how calcium scoring predicts real cardiovascular events, how plaque actually forms and progresses, and why some people with high cholesterol never develop plaque—while others with “normal” labs do.

This episode focuses on how to measure your actual cardiovascular risk, not just estimate it.

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In this episode, we cover:

• Why CAC scoring is one of the strongest predictors of future heart events
• Why cholesterol is critical—but only explains about half of heart disease risk
• Why some people with very high LDL have zero plaque—and others with normal labs have dangerous plaque
• Why CAC is best understood as the “tip of the iceberg” of total plaque burden
• When to escalate to CT angiography and advanced imaging
• How plaque regression is possible—and what interventions actually drive it
• The future of cardiac risk prediction: Lp(a), inflammation, and AI-driven plaque analysis

This conversation reframes heart risk around what’s actually happening inside your arteries—not just what shows up in bloodwork.

🎙 What Dr. Matthew Budoff & Mike Haney discuss:

[01:35] — Coronary calcium is the strongest predictor of heart events

[02:38] — What a high calcium score actually means for risk

[04:00] — Why rising calcium is not “healing.”

[11:07] — The role of fat tissue and inflammation in plaque formation

[16:37] — Why do many people with high cholesterol have no plaque

[17:55] — Why imaging is the only way to truly know your risk

[37:07] — Calcium as the “tip of the iceberg” of total plaque burden

[~52:00] — Why CAC is the practical first step before advanced imaging

[~1:02:00] — When CT angiography adds critical information

[~1:14:00] — How plaque regression actually happens in the real world

[~1:22:00] — The next frontier: Lp(a) and inflammation as treatment targets

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Look for new shows every month on A Whole New Level, where we have in-depth conversations with thought leaders about metabolic health.

🔗 Helpful links

Watch the conversation: ⁠https://youtu.be/os-RNhIS3jQ

Find us on YouTube: ⁠https://youtube.com/levelshealth?sub_confirmation=1⁠

📲 Connect

Connect with Dr. Matthew Budoff on X: https://x.com/BudoffMd

https://www.calciumscan.com/