Which statement is correct regarding a CAC score of zero in low-to-moderate risk individuals?

Which statement is correct regarding a CAC score of zero in low-to-moderate risk individuals?

• A. A CAC score of zero confers a warranty period of about 15 years against mortality.
• B. A CAC score of zero guarantees no CV events for life.
• C. A CAC score zero indicates no risk of future CV disease.
• D. A CAC score zero is not useful in risk stratification.

Answer: (A)

A zero CAC score means very little calcified plaque and, in people who are otherwise low to moderate risk, a notably favorable near-term outlook. In practical terms, this translates to a low risk of cardiovascular events and death over the coming years—often described as a warranty period of about 15 years for mortality. The idea is that when the coronary arteries show no calcified plaque, the short- to intermediate-term threat from plaque rupture or progression is substantially reduced, assuming risk factors are managed and no new risk factors emerge. This concept helps explain why the statement is considered correct: it captures the strong prognostic implication of a CAC score of zero for mortality risk over a long horizon, not a lifetime guarantee. However, it’s important to recognize that risk is not zero forever— risk can accrue with aging, new or worsening risk factors, or development of non-calcified plaque that CAC scoring may miss. The other options misstate the limits of CAC=zero. It does not guarantee no cardiovascular events for life, nor does it imply no future CV disease at all. And zero CAC is indeed useful for risk stratification, helping clinicians refine risk estimates and guide preventive strategies.

A zero CAC score means very little calcified plaque and, in people who are otherwise low to moderate risk, a notably favorable near-term outlook. In practical terms, this translates to a low risk of cardiovascular events and death over the coming years—often described as a warranty period of about 15 years for mortality. The idea is that when the coronary arteries show no calcified plaque, the short- to intermediate-term threat from plaque rupture or progression is substantially reduced, assuming risk factors are managed and no new risk factors emerge.

This concept helps explain why the statement is considered correct: it captures the strong prognostic implication of a CAC score of zero for mortality risk over a long horizon, not a lifetime guarantee. However, it’s important to recognize that risk is not zero forever— risk can accrue with aging, new or worsening risk factors, or development of non-calcified plaque that CAC scoring may miss.

The other options misstate the limits of CAC=zero. It does not guarantee no cardiovascular events for life, nor does it imply no future CV disease at all. And zero CAC is indeed useful for risk stratification, helping clinicians refine risk estimates and guide preventive strategies.