A calcium score of zero in a middle-aged patient at borderline or intermediate risk signals a low event rate over the next decade, and is a reasonable basis for deferring a statin after discussion.
It does not apply to smokers, people with diabetes or a strong family history of premature disease, where risk can be high despite a zero score. It does not rule out non-calcified plaque, and it does not last for ever — a repeat scan is usually considered after several years.
A score above zero, by contrast, confirms atherosclerosis and supports treatment.
- Zero is reassuring at borderline or intermediate risk, not at high risk
- Smoking, diabetes and premature family history weaken the reassurance
- Plan a time to reconsider rather than treating zero as permanent
- Any calcium confirms plaque and strengthens the case for a statin
Why it matters
Patients hear 'zero' as 'all clear', and the exceptions are where harm happens.
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