Low coronary artery calcium score is associated with an excellent prognosis regardless of a person’s age, according to new Intermountain Health study.
(PRUnderground) April 1st, 2025
It has generally been accepted that having a coronary artery calcium (CAC) score of zero is a marker of a very low risk of having a cardiac event within the next five years. Age, however, is a strong contributor to coronary risk, increasing markedly as people get older.
Whether age-related risk factors diminish the low risk predicted by a zero coronary artery calcium score has been uncertain – until now.
A large study of more than 40,000 patients from cardiac researchers at Intermountain Health in Salt Lake City finds that a zero coronary artery calcium score, which shows no evidence of plaque buildup in the arteries of the heart, continues to be an accurate indicator of a low risk for a coronary heart event – even as a person ages.
Moreover, researchers found that patients with a zero coronary artery calcium score also had a two to three times lower risk of death from any cause at any age, including in seniors.
The findings from the Intermountain Health study were presented at the American College of Cardiology’s annual scientific sessions conference in Chicago. The study is important because as cholesterol-laden plaques in the heart’s coronary arteries age, they attract calcium.
“We found that a zero-plaque burden is not only highly prognostic of good heart health at any age, but also of excellent overall survival,” said Jeffrey L. Anderson, MD, principal investigator of the study and distinguished clinical and cardiovascular research physician at Intermountain Health. “Our findings show that having little or no coronary plaque predicts that people will live longer, healthier lives, including into their golden years.”
A coronary artery calcium score of zero indicates essentially no advanced coronary plaque in the heart’s arteries. A score of 1-99 indicates a mild case of plaque, a score of 100-299 a moderate case, and a score of 300 or more a high case of plaque buildup.
The risk of a coronary event in the overall population generally parallels cases of coronary artery calcium plaque, said Dr. Anderson.
For the retrospective study, Intermountain Health researchers identified 40,820 symptomatic patients over a 10-year period who were at primary coronary risk and who underwent a PET/CT scan, which creates images to quantify advanced, calcified plaque in the vessels of the heart.
Of that overall group, 8,170 patients had a coronary artery calcium score of zero, with 5,185 of those patients under age 65, and 2,782 patients 65 or older. Researchers then assessed coronary prognosis during an average follow up of over two years.
Intermountain investigators found that a zero coronary artery calcium score was predictive of a very low risk of coronary death or non-fatal heart attack and of death from any cause.
In the study, coronary events occurred in only 0.12% of younger patients and 0.25% of older patients, a non-significant difference.
Researchers also compared overall death or heart attack rates in those with the presence of coronary artery calcium to CAC-zero patients. They found two to three-fold lower event rates for people with zero coronary artery calcium scores in both older and younger age groups, demonstrating the value of a zero coronary artery calcium score at any age.
“It makes sense that if you have disease in your coronary arteries, you may also have vascular complications in other organs of your body,” said Dr. Anderson. “Given these results, a zero coronary artery calcium score may also be a predictor of not only very low coronary death but also of a lower risk of other causes of death.”
The next step in the research is to further explore the relationship between a zero coronary artery calcium score and all-cause death, including vascular diseases in other organs and even cancer, Dr. Anderson noted.
About Intermountain Health
Headquartered in Utah with locations in six states and additional operations across the western U.S., Intermountain Health is a not-for-profit system of 34 hospitals, approximately 400 clinics, medical groups with some 4,600 employed physicians and advanced care providers, a health plans division called Select Health with more than one million members, and other health services. Helping people live the healthiest lives possible, Intermountain is committed to improving community health and is widely recognized as a leader in transforming healthcare by using evidence-based best practices to consistently deliver high-quality outcomes at sustainable costs. For up-to-date information and announcements, please see the Intermountain Health newsroom at https://intermountainhealthcare.org/news.
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