Heart disease remains one of the leading health concerns in India, contributing significantly to morbidity and mortality across all age groups. With changing lifestyles, increased stress levels, and rising rates of conditions like diabetes and hypertension, more individuals are seeking ways to assess their personal risk for cardiac events. Advanced imaging tests such as CT Calcium Score (CTCS) and CT Coronary Angiography (CTCA) are now widely used to detect plaque accumulation in the coronary arteries, helping doctors and patients make informed decisions about prevention and treatment.



However, there is a common misunderstanding surrounding these tests. Many people assume that if a scan shows normal results, their heart disease risk is completely eliminated. Dr Sudhir Kumar, MD, senior neurologist at Apollo Hospitals, recently highlighted why this perception can be misleading and why some risks may remain undetected even with reassuring test results.





CT calcium scoring detects coronary plaque and predicts low heart disease risk



CT Calcium Scoring is designed to detect calcified plaque in the coronary arteries, which is a common marker of atherosclerosis. Dr Kumar referenced a major cardiology study that followed thousands of individuals with stable chest symptoms. Participants who recorded a zero coronary calcium score were found to have no detectable calcified plaque.



Subsequent CT Coronary Angiography confirmed that these individuals had a very low likelihood of significant coronary artery blockages . Long-term outcomes for these patients were excellent, demonstrating that CTCS can reliably identify people at low risk for major heart events in the near future. This makes calcium scoring a valuable tool, particularly for adults seeking reassurance about their cardiac health without undergoing invasive procedures.












Heart disease risk may remain despite a zero calcium score



Despite the strong reassurance provided by a zero calcium score, it does not guarantee lifelong immunity from heart disease. Dr Kumar emphasised that younger individuals or certain high-risk groups may carry soft, non-calcified plaque that CTCS cannot detect.



Soft plaques, though invisible on calcium scans, are clinically significant because they can narrow arteries or become unstable, potentially leading to heart attacks. Therefore, it is crucial to consider a calcium score in conjunction with other risk factors, such as diabetes, high blood pressure, cholesterol levels, smoking habits, and family history of heart disease. A normal CTCS result should never be interpreted as absolute safety.





Situations where hidden cardiac risk may be overlooked

• Soft plaque cannot be detected on CTCS

CTCS only identifies calcified plaque. Non-calcified or soft plaque, which can also obstruct arteries or trigger cardiac events, is not visible in this test. This limitation underscores the importance of evaluating patients’ symptoms and overall risk profile rather than relying solely on calcium scoring.

• Anginal symptoms require detailed imaging

Patients exhibiting chest pain or other symptoms consistent with angina often require CT Coronary Angiography. CTCA provides a more detailed view of coronary artery health, identifying both calcified and soft plaque and helping physicians determine the most appropriate treatment strategy.

• High-risk individuals need comprehensive assessment

People with pre-existing heart conditions, multiple risk factors, or strong family histories of heart disease should undergo more comprehensive imaging, such as CTCA, rather than relying solely on a calcium score. In such cases, detailed imaging is essential to guide treatment decisions, including medication, lifestyle modification, or procedural intervention.





When calcium scoring is most effective



According to Dr Kumar, CTCS is particularly useful in certain scenarios:



Adults over the age of 40 with mild or borderline risk factors who want a clearer picture of their heart health

Individuals experiencing vague or mild chest discomfort where the probability of a major arterial blockage is low

People seeking to personalise preventive strategies, such as decisions regarding statin therapy or lifestyle interventions



For these groups, a zero calcium score can provide reassurance, reduce unnecessary interventions, and support informed preventive measures.





What patients should keep in mind



Dr Kumar advises that imaging tests should be used selectively and under medical guidance rather than as routine screening tools. Both CTCS and CTCA involve radiation exposure, and their benefits should be weighed against potential risks.



He also stresses that lifestyle interventions remain the cornerstone of cardiovascular health. Regular physical activity, smoking cessation, and the control of blood pressure, blood sugar, and body weight are essential regardless of imaging results. No test can replace the importance of healthy daily habits in reducing long-term heart disease risk.









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