Zero coronary calcium does not mean zero cardiovascular risk

Peter Attia · 1 Aug 2026

Others here said this too

A coronary calcium score of zero does not mean the arteries are free of disease, and in a younger adult it is far weaker reassurance than it looks.

Their wordsIn other words, the absence of calcium is not the same as the absence of disease—it may simply mean the disease hasn’t reached the stage CAC is designed to detect.

Also said by Eric Topol

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Our reading
A coronary calcium score of zero does not mean the arteries are free of disease, and in a younger adult it is far weaker reassurance than it looks.
Mental modelThe map is not the territory

Their wordsIn other words, the absence of calcium is not the same as the absence of disease—it may simply mean the disease hasn’t reached the stage CAC is designed to detect.
Our reading
A zero calcium score is only as reassuring as the rest of the risk profile it sits in.
Mental modelProbabilistic thinking

Their wordsA zero calcium score is reassuring, but it is most reassuring when the rest of the risk profile points in the same direction.

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