Final Step: put it all together.

Look at your three scores.

You’ve got a zero calcium score (1% 10 year risk). And you’ve got 2 MESA scores:

  • your 10 year risk calculation with the calcium score

  • your 10 year calculated risk (based on your risk factors alone) without the calcium score.

Of the two MESA scores, which one is the highest? Circle that one. That’s the most important risk score for you. Because when your MESA score without the calcium is higher than the MESA score with the calcium, it means that your actual risk may be higher than the calcium score reflects. Read the section below very carefully under “Who might be at risk of a heart attack with a 0 calcium score.”

Remember that normal (low or safe) risk is when your 10 year risk is less than 7.5%.

Lipid doctors (cholesterol specialists) label any score above 7.5% as high risk. Cardiologists call it moderate risk.

Using the cardiology model, moderately high 10 y risk is between 7.6% and 19%. High risk is over 20%.

And you must also remember this: your risk is not the end of the story. Your risk does not determine your future. It can. But not if you determine your future. You can reduce your risk. A lot.

Heart calcium scans are a great screening tool for people who don't have symptoms.

If you are having these symptoms, keep reading.

Are you having chest discomfort? Shortness of breath when exerting? When walking up a flight of stairs? Do you get nauseated or dizzy when you exert yourself? Or do you have arm or shoulder or neck pain when physically active?

If you are having symptoms that might be heart disease, go to the Emergency Room or call your doctor without delay.

Who might be at risk of a heart attack with a 0 calcium score?

People with:

  • Younger age (under 45)

  • Artery disease that is getting worse rapidly. Rapidly growing plaque may not calcify.

  • Soft plaque (the most dangerous kind that ruptures and forms clots) has NO calcium. So calcium scans miss soft plaque.

  • Lots of risk factors or heart attacks in the family

  • Diabetes

  • In this study of people with severe blockage (getting stents or bypass), women and younger men (1)

  • MESA risk score without your calcium (the second MESA number) is higher than your risk with the calcium score (see reference 2 below)

Talk to your doctor about your symptoms.

The most important question for a doctor is this: “Is my treatment plan working or not?”

If you fit one of the categories above, and have concerns about your risk, feel free to call us.

If you want to take no chances:

Consider using a different technology to confirm that your plaque is not getting worse rapidly, and to look for the soft plaque that doesn’t show up on the calcium score. Our Ask the Arteries program uses ultrasound technology to test the arteries 2 times, 3 months apart, to determine whether your plaque is stable, getting better, or getting worse. Know your arteries.


  1. In this study of 291 patients referred for heart catheterization, 12% of the patients with 0 calcium scores had severe blockage requiring re-vascularization (angioplasty, stent or bypass). Of 64 totally occluded coronary arteries in the study, 20% had no calcium.  Patients with severe blockage but normal calcium scores tended to be women or younger men. Gottlieb I, et al. The absence of coronary calcification does not exclude obstructive coronary artery disease or the need for re-vascularization in patients referred for conventional coronary angiography. J Am Coll Cardiol. 2010 Feb 16;55(7):627-34.

  2. If your MESA risk estimate without the calcium score is higher than your risk with the calcium score, then your calcium score might not reflect your actual disease process right now. A different technology might better reflect what’s really happening in your arteries. That’s why we developed our ultrasound technology, Ask the Arteries.