The coronary calcium scoring procedure is very accurate at predicting the likelihood of the presence of heart disease, but does this mean that a result of zero automatically means you can’t possibly have any heart disease?

“Yes, even if the calcium score is zero, one can still have some form of heart disease,” says Dr. Sameer Sayeed, a cardiologist at ColumbiaDoctors of Somers, NY.

“A calcium score of 0 usually means that there is no significant coronary artery disease, or there may be coronary artery disease in the form of a soft non-calcified plaque that can still rupture and cause a heart attack.”

The test that can show this soft, non-calcified plaque is the CT angiogram.

If you have soft plaque, it won’t necessarily be built up enough to restrict blood flow in your heart (and cause chest pain).

The type of plaque that restricts blood flow is the hard, calcified type.

Thus, if a person has angina (chest pain from “clogged” arteries restricting blood flow), this doesn’t mean they also have a lot of soft plaque too; in fact, there’s no correlation.

A person can have a calcium score of 1,000 and chest pain from exertion, yet have very little soft plaque.

He may never have a heart attack — unless the hard plaque builds up enough to literally obstruct the vessel, blocking 100 percent of the blood flow through it.

This isn’t a rupture. A rupture of soft plaque means a piece of it has broken off and has lodged in what can be an otherwise clear vessel, blocking blood flow.

Imagine a pea inside an otherwise clean straw. Imagine that the pea-sized blockage broke off from a larger mass of the “pea” further upstream from that point, in a wider vessel.

“Even though there may be a minor buildup of soft plaque, it can still rupture,” says Dr. Sayeed.

“A zero calcium score only tends to rule out significant coronary disease, but it doesn’t mean that the structure of the heart is normal or that the pump function or the valvular function of the heart is normal,” says Dr. Sayeed.

“These could all be a problem and yet the calcium score can be 0 and be misleading.”

An echocardiogram will reveal cardiac structure, pump and valvular function.

“Even if the calcium score is 0 and no soft plaques are obviously detected, there may still be vulnerable plaques that are too small to be seen and can cause the so-called healthy person heart attack or sudden death.”

What can you do to reduce soft plaque or stop the progression of soft plaque?


  • Green tea supplementation
  • Magnesium citrate supplementation
  • Krill or cod liver oil supplementation (high doses)
  • Avoid manmade sugars as much as possible.

Dr. Sayeed performs echocardiograms and stress tests at the Midtown Manhattan and Westchester offices at Columbia Doctors. He is also trained in cardiac CT imaging.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.  


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