Coronary artery calcium testing may hold limited value for many people, according to new research.
Screening for heart disease remains a critical public health priority in the United States, where heart disease remains the number-one killer of both men and women. Yet the clinical utility of diagnostic testing continues to undergo rigorous reassessment. Recent medical research highlights both the limitations and the broader prognostic implications of imaging technologies designed to detect plaque buildup in the heart’s arteries.
Intermountain Health Study Links Calcium Scores to All-Cause Mortality
A large, retrospective study conducted by researchers at Intermountain Health in Salt Lake City examined the medical records of 40,018 Intermountain Health patients, whose doctors determined they were at risk of having or developing heart disease, and as part of that care, underwent a PET/CT stress test. Of that cohort, 7,967 had no evidence of coronary artery calcium, and 32,051 had some levels of CAC. Following patients for five years, investigators tracked all- cause mortality of people with a CAC score of zero compared to those with a CAC score of greater than zero.
The findings revealed that people who had any level of coronary artery calcium were 2 to 3 times more likely to have died than those without CAC in those five years. Furthermore, of those with CAC who died, only about one quarter did so from cardiovascular disease. That means most of these patients died of something else, including non-cardiovascular diseases, suggesting that arterial plaque correlates with broader systemic health risks.
“We know that not having any coronary artery calcium is a predictor of being in good coronary health, but we were surprised to find that it may also be a sign you’re in good general health,” said Jeffrey L. Anderson, MD, distinguished clinical and research physician at Intermountain Health and principal investigator of the study. “Someone’s coronary artery calcium score could be a more powerful predictor of a person’s overall health than we previously thought. We don’t know the mechanism for this extended benefit, but coronary plaque may be correlated with plaque in blood vessels in other parts of the body, and having atherosclerosis may also negatively impact immune surveillance, an important protective mechanism against cancer.”
While the biological mechanism connecting coronary plaque to non-cardiac mortality remains unproven, researchers say they’re not sure why patients’ all-cause mortality rates were higher for those with evidence of coronary artery calcium. The next step in this research, they say, is to examine those non-cardiovascular deaths, and better stratify the causes behind them.
This may help uncover the mechanism of why a coronary artery calcium score predicts death due to non-coronary artery problems,” said Dr. Anderson. “It’s not clear to us right now, and it requires more study, but it’s a very interesting observation and suggests that coronary artery calcium h
Refining Risk Assessment and Cost-Effective Cholesterol Testing
Parallel research published in JAMA from Northwestern Medicine points toward alternative blood testing strategies to better guide preventive care. A routine blood test taken by millions in the U.S. each year to measure “bad” cholesterol is not the best measure to guide treatment and prevent heart attacks and strokes, suggests a new Northwestern Medicine study published in JAMA. To evaluate how different biomarkers perform in predicting cardiovascular risk, the Northwestern scientists used a large computer simulation model representing 250,000 U.S. adults eligible for statins but without existing cardiovascular disease.
- LDL cholesterol (goal <100 mg/dL)
- Non-HDL cholesterol (goal <118 mg/dL)
- ApoB (goal <78.7 mg/dL)
If patients did not meet their assigned goal, treatment was intensified first with stronger statins, then by adding another medication, ezetimibe. The analysis concluded that apoB-guided care outperformed the other two strategies, improving population health and saving more lives in a cost-effective manner. According to study lead author Ciaran Kohli-Lynch, assistant professor of preventive medicine in the division of epidemiology at Northwestern University Feinberg School of Medicine, this is the first comprehensive study to show that using apoB testing to guide cholesterol-lowering treatment is cost-effective.
“We found that apoB testing to intensify cholesterol-lowering medication would prevent more heart attacks and strokes than current practice, and that these health benefits were achieved at a cost that represents good value for U.S. healthcare payers,” said study lead author Ciaran Kohli-Lynch, assistant professor of preventive medicine in the division of epidemiology at Northwestern University Feinberg School of Medicine.
Clinical Implications and Upcoming Scientific Presentations
The timing of these findings coincides with new guidelines issued by the American Heart Association and 10 other medical associations earlier this year that recommended starting cholesterol-lowering therapy at younger ages for many patients. As clinical practice shifts toward earlier intervention, identifying who would benefit most from intensive treatment has become increasingly critical.
Data from the Intermountain Health study were presented today at the American Heart Association Scientific Sessions 2025 in New Orleans. Other Northwestern study contributors are Drs. John Wikins (co-senior author) and Samuel Luebbe (first author), and the study was supported by the American Heart Association Career Development Award.
