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The Coronary Artery Inflammation Controversy

Eric Topol · 5 Sept 2026

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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 wordsWe know that arteries with a calcium (CAC) score of zero can be highly inflamed, and that high CAC scores are not necessarily high-risk for cardiovascular events.

Also said by Peter Attia

Read the piece on erictopol.substack.com ↗

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Eric Topol did not write this page.

Every claim below was made in this piece, quoted word for word and numbered in the order the piece makes them, so you can read it there rather than take our word for it. The sentence above each quote is our reading of the claim, not their wording. Each quote was checked against a stored copy of the page at build time; where the two differ, the quote is the fact.

  1. Our reading

    A drug that moves a surrogate blood marker in the right direction cannot be assumed to prevent heart attacks and strokes.

    Mental modelThe map is not the territory

    Their wordsWe can’t count on surrogate blood markers to guide the results of cardiovascular clinical outcome trials.

  2. Our reading

    Inflammation's role in coronary artery disease is proven, not hypothetical; what is missing is a safe and potent way to reduce it.

    Their wordsThe “inflammation hypothesis” is not a hypothesis.

  3. 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 wordsWe know that arteries with a calcium (CAC) score of zero can be highly inflamed, and that high CAC scores are not necessarily high-risk for cardiovascular events.

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