The coronary artery calcium (CAC) scan — usually reported as a “calcium score” — is one of the most popular heart tests around, and I’m going to take an unpopular position: in my experience, for most people, a calcium scan does more harm than good. After more than two decades as a cardiologist and electrophysiologist, here’s why.
It confirms something I already assume
A calcium score is meant to tell you whether you have coronary artery disease. But atherosclerosis begins early and is nearly universal in adults living a modern lifestyle — I assume essentially everyone has some. A test that confirms what I already take for granted doesn’t change what I do.
It measures the plaque that won’t hurt you
This is the crux. A calcium score lights up calcified plaque — old, hardened, stable plaque. And stable, calcified plaque is generally not what causes heart attacks; it doesn’t rupture. The lesions that actually kill people are the soft, inflamed, non-calcified ones that rupture and trigger a clot — and those are invisible to a calcium scan. So the test is busy measuring the plaque that’s least likely to harm you, while missing the plaque that is.
And a high score leads to procedures that don’t save lives
When a calcium score comes back high, it often kicks off a cascade — an angiogram, and then an elective stent to “fix” a narrowing. But the evidence here has been clear for years: for stable coronary disease, elective stents do not reduce the risk of death or heart attack compared with good medical and lifestyle management. (This is entirely different from a stent placed during an actual heart attack, which is genuinely life-saving.) An elective stent may relieve symptoms in selected cases, but it is not extending anyone’s life. So the scan frequently sets off a chain that ends in an unnecessary stent — a real procedure, with real risks (bleeding, vessel injury, and a lasting commitment to blood-thinning medication) — that does nothing to help you live longer. That isn’t a neutral test result; that’s harm.
And the radiation is not harmless
We tend to treat medical imaging as if it were free. It isn’t. A 2025 analysis in JAMA Internal Medicine estimated that the CT scans performed in the United States in a single year could eventually cause on the order of 100,000 future cancers — potentially as much as 1 in 20 new cancer cases. And sit with what that number actually is: it’s CT scans alone, in one country, in one year. It doesn’t count the X-rays, nuclear stress tests, and catheter angiograms layered on top, and it doesn’t count the rest of the world. The real toll of medical radiation is larger still. A calcium score is rarely the end of the line, either — a high number frequently sends people on to more imaging, each study adding its own dose of ionizing radiation.
So this is not a harmless test
Add it up: we’ve delivered radiation — with a real, measurable cancer cost — to produce a number that either falsely reassures, or sets off still more radiation and unnecessary stents that carry their own risks and don’t lower the odds of dying. A calcium scan isn’t a neutral “nice to know.” For most people, the realistic outcomes run from useless to actively harmful.
What I do instead
I skip the question “Do you have plaque?” — you almost certainly do — and focus on the one that matters: will that plaque stay quiet, and what’s driving it? That’s answered by addressing the true drivers of plaque progression and rupture — inflammation, insulin resistance, blood pressure, ApoB and particle number, diet, and lifestyle — for everyone, not just people with a frightening scan. It’s a plan you can act on today, and it doesn’t require a CT scanner.
This is my clinical opinion, offered for general education — not medical advice. If a calcium score, angiogram, or stent has been recommended to you, talk it through with your own physician; don’t change anything based on an article.
About the author: Andrew Rudin, MD is a cardiologist and board-certified cardiac electrophysiologist with more than two decades of experience. He works as a consultant helping patients take a natural, root-cause approach to heart health — through diet, lifestyle, and targeted supplements — seeing patients nationwide via telehealth through Natural Heart Doctor. He is licensed in New York and Tennessee and has been featured as an expert source in Medscape and Men’s Journal. Learn more at andrewrudin.com.
This article is for general educational purposes and is not medical advice. It is not a substitute for care from your own physician, and nothing here should be used to start, stop, or change any treatment on your own.