The Heart of Prevention Seeing Atherosclerosis: How Coronary Calcium Transforms Risk Assessment
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Mar 18, 2026 
Khurram (Kerem) Nasir, a preventive cardiology leader at Houston Methodist, and Michael Blaha, a Johns Hopkins cardiology and epidemiology researcher, discuss coronary artery calcium scoring. They explain what a CAC scan is. They cover who benefits most from scanning. They explore the “power of zero,” how to interpret low positive scores, when to repeat scans, and common misconceptions.
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CAC Is A Simple Standardized Window Into Atherosclerosis
- Coronary artery calcium (CAC) directly images atherosclerosis and is simple, rapid, reproducible, and globally standardizable.
- Michael Blaha stresses non-contrast gated CT takes minutes, uses the same acquisition and scoring worldwide, enabling scalable risk detection.
CAC Changes Risk Estimation Into Disease Detection
- CAC shifts assessment from risk estimation to disease detection by showing who actually has plaque versus who only has risk factors.
- Khurram Nasir: LDL reflects what's floating; CAC reveals what's sticking, directly identifying disease presence.
Scan When Risk Is Uncertain Before Lifelong Therapy
- Use CAC when clinical risk is uncertain, especially in borderline or intermediate-risk patients where treatment decisions are unclear.
- Khurram Nasir advises scanning before lifelong preventive therapy to reclassify risk and apply the 'power of zero' for deferral.