Understanding Your Heart Health
How CAC Scoring and Cardiac CT Help Prevent Heart Disease
Goal of this article: help you understand the most common heart imaging tests we use at Paradigm Health, in plain English, and show you how the results guide a personal prevention plan.
Why we care about early detection
Heart disease often builds for years without symptoms. Many people feel fine until a heart attack or stroke is the first warning.
Early detection matters because it gives you time to:
lower risk before something happens
Choose the right targets for cholesterol and inflammation
Use the right tools (lifestyle, supplements, and medications when needed)
What is plaque, and why does it matter?
Plaque is a buildup inside the arteries that feed your heart. It is made of cholesterol, inflammatory cells, and sometimes calcium.
There are two main types:
Stable plaque
has a thicker “cap.”
tends to be more calcified
Usually grows slowly
Vulnerable plaque
has a softer, fatty core
has more inflammation
can rupture suddenly
Most heart attacks happen when a vulnerable plaque ruptures, and a clot forms.
Key point: risk is not just about whether you have plaque. It is also about how much plaque you have and what kind it is.
Why lab work alone is not always enough
Cholesterol, blood pressure, and blood sugar are important. But risk calculators estimate averages across large groups.
Two people can have similar lab numbers, but very different plaque buildup.
That is where imaging helps. Imaging lets us see the disease process in your arteries, not just the risk factors.
Test 1: Coronary Artery Calcium (CAC) score
A CAC scan is a quick, noninvasive CT scan that measures calcified plaque in the coronary arteries.
It reports an Agatston score.
What the score ranges usually mean
0: no detectable calcified plaque
1 to 99: mild plaque burden
100 to 399: moderate plaque burden
400 or higher: higher plaque burden and higher risk
Why CAC is useful
it is fast and low hassle
it can move someone from “low risk on paper” to “higher risk in real life”
it helps us decide how aggressive prevention should be
Important nuance
A CAC score of 0 is reassuring, but it is not the whole picture.
CAC measures calcified plaque. It does not show noncalcified (soft) plaque, which can still be present.
Test 2: Cardiac CT Angiography (CTA)
CTA is a CT scan done with contrast that lets us see:
the blood flow channel inside the artery
the artery wall
plaque that is calcified, mixed, or soft
Why CTA matters
CTA can detect soft plaque, which CAC can miss.
If the goal is to understand plaque type and total plaque burden, CTA is often the more complete tool.
Cleerly Analysis: a more detailed plaque report
Cleerly is an AI-driven analysis that takes CTA images and turns them into a detailed map of your coronary arteries.
Instead of only saying “plaque is present,” it can help quantify:
how much plaque there is
where it is located
What it is made of (more stable vs more vulnerable patterns)
Why Cleerly is powerful
Cleerly can help us:
find higher risk, noncalcified plaque that CAC might miss
track plaque progression or regression over time
build a more targeted prevention strategy
How we use these results in real life
At Paradigm Health, we do not make decisions based on one number.
We combine layers of information:
Your history and exam
Lab markers (often including apoB, lipoprotein(a), LDL particle measures, and inflammatory markers)
Imaging (CAC, and CTA with analysis when appropriate)
This helps us set clear goals for:
apoB and LDL particle burden
triglycerides and insulin resistance
inflammation
Then we choose the right tools:
nutrition and activity plan
sleep and recovery
supplements when appropriate
prescription medications when needed
and sometimes referral to cardiology
Who should consider CAC or CTA?
These tests can be helpful if you:
have a strong family history of early heart disease
have high blood pressure, high cholesterol, diabetes, or metabolic syndrome
have elevated apoB or lipoprotein(a)
want a clearer picture than risk calculators provide
are deciding how aggressive prevention should be
Not everyone needs the same test. The right choice depends on your history, labs, and goals.
What to do next
If you want to understand your personal risk, the fastest path is a focused consult where we review your history, labs, and decide whether imaging makes sense.
Book a consult: Team@paradigmhealth.org
Prefer to start with a question?
Send in a question: team@paradigmhealth.org