We are in a golden age of medical science, yet a dark age of healthcare delivery. Coronary artery disease, America's leading cause of death and disability, illustrates the problem. More than 800,000 Americans suffer a heart attack each year, and most of these events are preventable.
The coronary artery calcium (CAC) score is a simple 10-minute scan that detects coronary atherosclerosis many years before it causes a heart attack. It costs about $100 and uses a fraction of the radiation of a standard chest CT. In March 2026, the American College of Cardiology and American Heart Association gave CAC a central role in their national guidelines for preventing coronary artery disease. It is recommended for adults with borderline or intermediate risk for whom the decision to start statin therapy remains uncertain.
Risk calculators built on age, sex, cholesterol, diabetes, blood pressure and smoking estimate probability, not the actual presence of plaque. A CAC scan detects the disease itself. A patient with low cholesterol may already have extensive plaque, while another with high cholesterol may have none. A score of zero can avoid unnecessary statins, while a score above 100 may justify aggressive treatment. In one case, a 52-year-old patient with borderline cholesterol and a family history scored 220, showing substantial plaque that the standard calculator missed.
CAC scanning has been included only peripherally in national guidelines for about 35 years, partly because clinical tools were built around population averages and insurers often do not cover the test. Artificial intelligence may change that by identifying calcification on chest CT scans patients already receive, flagging those who should be evaluated for prevention.
Source: Hacker News · Summarized by HeadlinesBriefing