Individuals of Indian background at age 43 with a zero CAC score who subsequently have a heart attack may have soft plaques and exhibit metabolic dysfunction.

“let's say you take a person of my Indian background and let's say that they are 43 years of age and they come in get a calcium score done and their calcium score is zero and then few months later or a few days later they end up having a heart attack right possible it's possible the reason it's possible is because these people have soft plaques but if you look a little further into them you will find that they have fatty liver that they are insulin resistant that they have high triglycerides low HDL their LDL by the way may not be very high actually it may be on the low side they would have high inflammation markers they have impaired glucose tolerance”