A coronary artery calcium score of zero in young individuals (e.g., under 25 or 45-50) provides no additional risk stratification and is meaningless for risk assessment.

“My takeaway is, even if you have a zero CAC score, you should focus on the biomarkers and not the CAC. Vulnerable plaques are nasty.”

“Zero CAC means lower risk than high CAC, but so often gets interpreted as "zero" risk, erroneously.”

“So in a 25-year-old or my 15-year-old daughter, is going to have a calcium score of zero. It's meaningless for her. It gives you absolutely no additional risk stratification.”

“and more to your point it's what it says about the milieu of the entire system so yeah that might be the one area in the middle of your left anterior descending artery where you're at such an advanced stage that you've already laid calcium there”

“we know that even that doesn't work very well in the younger population that we're talking about less than 40 because it takes time for plaque to calcify and so a zero calcium score a young adult isn't as reassuring as a zero score in an older adult you know they get they might be at low risk the short term for sure but they may still have high lifetime risk”

“in people who are younger than 60 can this give you extra information if you're on the cusp of saying should you be treated or not and I think the answer is yes if you or the patient says I want more information I'm not convinced that I personally are in a situation where I should be taking medications and you have a positive coronary calcium I think that can be extremely helpful”

“again a calcium score in an ideal world is zero but it's always important to remember that there's about a 15% false negative”