Our genetic tendencies toward disease are hidden risks under our surface — we are often unaware of them until it’s too late!

I saw a patient, typical for my practice, where both of his parents suffered their first heart attack in the 50s. His dad had open-heart surgery, with 5-way bypass in his 60s. His younger brother just had a heart attack earlier that week, at age 48. And NONE of them smoked…

Understandably, my patient was fearful for his own life! A big burley man…he was visibly trembling as he related his family history, moved to tears when discussing his brother’s tragedy.

His calculated ASCVD risk was LOW at 4% over 10 years. But clinical calculators fail to account for this strong family history of early-onset coronary artery disease (CAD). SO — I sent this 52-year-old man down to get a Cardiac Calcium Score right away.

His score was 875 (99th percentile for age/sex/race). His adjusted 10-year ASCVD risk was now >30%! Besides an HDL of 38 mg/dL his cholesterol panel looked pretty good (LDL 138).

After our next office visit he starting taking Atorvastatin 80mg daily. He started working out with a trainer four days a week, and began losing the 15 pounds he put on over the last few years. He opted to take a baby aspirin. With these interventions he reduced cut his REAL risk of heart attack in half!  And when he had a screening stress test, he got good news — it was normal.  And NOW, he should do GREAT!

This scenario seems like a no-brainer to me, and the many who practice preventive cardiology routinely incorporating CCS. But many doctors would have simply sent him for a falsely reassuring, screening stress test. Stress tests are normal in 9-out-of-10 high risk, asymptomatic patients! 

Other doctors argue they could have achieved the same outcome without CCS — but studies clearly demonstrate improved compliance with both lifestyle and medications after CCS. More than simply achieving “buy-in” from patients, CCS can truly pick out who is at-risk for heart attack. It’s not quite a crystal ball, but it is the closest thing we have.

I’m sharing this case as a single, easily understood example of a “LOW RISK” patient who should be screened with CCS. A strong family history, ongoing smoking, or diabetes are often reasons to use CCS even prior to reaching an “INTERMEDIATE” level of ASCVD risk (10-20%).


If you have a family history of heart attack or sudden death, don’t wait for symptoms to consider CCS — the first symptom for most people is a heart attack or sudden death! Consider CCS when you are 10 years younger than your relative with an event.