Coronary Artery Calcium Score (CAC)

Cardiovascular

Vascular Imaging

Agatston units

The coronary artery calcium (CAC) score uses a low-dose CT scan to quantify calcified plaque in the heart's arteries, giving a direct picture of accumulated atherosclerosis. A longevity practice values it because a score of zero signals very low near-term risk, while higher scores reveal established disease that lab values alone can miss.

What It Measures

CT scan measuring calcified plaque in coronary arteries; direct visualization of atherosclerosis burden

Optimal vs. Lab Range

Longevity Optimal

0 (zero score = very low risk for 5–10 years)

Target range for optimal health and longevity based on research.

Standard Lab

0 = no plaque detected

Population-based reference range from standard labs.

Why It Matters

CAC directly visualizes calcified atherosclerotic plaque in the coronary arteries. A score of 0 confers very low 5–10 year cardiovascular event risk; scores >100 indicate established disease and substantially elevated risk regardless of cholesterol numbers.

When Low

N/A — 0 is the optimal floor

When High

>0: plaque present (1–99 mild, 100–399 moderate, 400+ severe); Agatston score quantifies burden

How to Optimize

CAC scores rarely regress, but progression can be slowed: aggressive LDL/ApoB lowering (statins, ezetimibe, PCSK9i), blood pressure control, low-dose aspirin where indicated, vitamin K2 (MK-7), exercise, and elimination of smoking and metabolic syndrome.

Key Interventions & Linked Compounds

Strong evidence

Key Interventions

Aggressive lipid management if >0

statin (clinical)

lifestyle

aspirin (clinical debate)

Linked Compounds & Supplements

Vitamin K2 (may slow progression)

Omega-3

Aged garlic extract

Curated from clinical literature. Individual results vary; consult a qualified clinician before changing a protocol.

Ordering Notes

Specimen

Serum or plasma (venous draw)

Patient prep

No fasting required. Maintain usual diet and medications unless advised.

Recommended cadence

Every 3–5 years (if 0); more frequent if elevated

Reporting unit

Agatston units

Pre-analytic notes

Standardize draw time of day, hydration, and recent exercise. Note any acute illness, supplements, or hormonal therapies on the requisition.

Recommended Follow-Up Actions

1
Confirm the result is reliable
Repeat abnormal values before acting — preferably from the same lab, same time of day, and under consistent prep. Rule out acute illness, recent intense exercise, or medication effects that can shift Coronary Artery Calcium Score (CAC).
2
Compare against optimal, not just lab range
Use the optimal window above as the target. Lab "normal" is built from the general population and often misses early dysfunction.
3
Pair with related markers
Order a complementary panel covering metabolic, inflammatory, and hormonal context to interpret this marker properly.
4
Discuss interventions with a clinician
Use the interpretation guidance above to frame the conversation. Bring trends, not just one datapoint, to your visit.
5
Re-test on a defined cadence
If a change is implemented, re-measure in 8–12 weeks for fast-moving markers, or 3–6 months for slower ones, to confirm response before escalating.