What a CAC Score Tells You: Cardiologist Dr. Ilan Kedan Explains

A man Mike Torchia knew got up one morning, said good morning to his girlfriend, and fell face forward. He was about 52. Afterward, Mike said, they found severe blockage. Nobody had told him he had a heart problem, because nobody had looked.

That is the case for a CAC score, the number that comes back from a coronary calcium scan. It is a screening test for people who feel fine, and on this episode a cardiologist described it in a few plain sentences that most people have never heard.

In episode 40 of Live Well and Thrive, Mike sat down with Dr. Ilan Kedan, a cardiologist in Beverly Hills who runs a concierge practice. The companion post covers the signs of heart problems you cannot feel and what his handheld ultrasound can see. This one covers the test side: what a calcium heart scan is, what a zero result buys you, how often you repeat it, what happens when calcium shows up, and what each kind of imaging exposes you to.

A CAC score comes from a low-dose X-ray with no contrast

Late in the conversation, after Mike told the story of his friend, Dr. Kedan made the point that screening tests for heart disease exist the same way they do for cancer. Women get a mammogram at a certain age. Adults get a colonoscopy. Heart disease has an equivalent, and most people have never had it.

We have a test to screen for calcified buildup of calcium in the heart, coronary calcium. That is X-rays, but there’s no contrast.

The test is a CT calcium score, and Dr. Kedan described it in three parts. It is an X-ray of the heart. It uses no contrast agent, which matters to anyone who has felt sick after contrast, and Mike has. And it is a low dose of X-ray radiation, not a high amount, in his words. The result is a number that reflects calcium in the walls of the coronary arteries, the vessels that block in a heart attack.

Mike opened the episode by describing a scan for plaque in arteries. Dr. Kedan’s version of that screen is narrower and more specific: it looks for calcified buildup, the part of the disease an X-ray can see. If you have been searching how to check for clogged arteries, this is the screening test he named.

He also said where it happens. It is not done in his office and not with the probe he carries. It is a send-out, ordered by a physician and performed elsewhere, and he gave no price for it.

A zero on the CAC scan predicts low risk for 10 to 15 years

The reason Dr. Kedan brought the test up is what a normal result tells you.

If you have a normal study, it’s not a warranty per se, but it predicts low risk of any kind of event for 10 to 15 years.

Mike asked whether that meant a zero. Dr. Kedan’s answer was that a zero is the normal result. Read his phrasing carefully, because he chose it. Not a warranty. A prediction. A zero buys you a decade or more of predicted low risk, which is the closest thing to reassurance a cardiologist offered in 37 minutes.

He did not say what CAC score is good, and this post will not either. He gave no cutoff between a little calcium and a lot, and no number at which treatment starts. The reading belongs to the physician who orders the scan, alongside your history and your goals.

One sentence of general context, not from the episode: a screening scan is for people without symptoms, so if you have chest pain or shortness of breath, call emergency services now.

You repeat a calcium heart scan every five to ten years, sometimes once

Mike’s instinct, from a lifetime of blood work every four months, was to ask how often. For the ultrasound, Dr. Kedan scans at every visit. For the CAC score the answer is different.

It’s once every five to ten years, and maybe once in a lifetime. If you have a lot of buildup and you have calcium built up, then we know it’s there, and then we treat.

By his account, that cadence follows from what a normal result predicts. A test that reads 10 to 15 years ahead is not a test you repeat next year.

He also put the scan in its place among screens. Earlier in the episode, Mike asked how often a 50-year-old with no symptoms should see a cardiologist. Dr. Kedan said the preventive care associations do not generally recommend a screening exam from a cardiologist at all. What they recommend is screening for four chronic conditions: hypertension, diabetes, thyroid disease and cholesterol, plus or minus imaging of the coronary arteries. The calcium scan is that plus or minus. It is the optional line on the list, not the first line.

How you act on any of it, he said, is a value judgment. The same one percent risk relaxes one person and sends another for checks three times a year. Whether you have had an event, your goals, your resources, and your comfort level all go into the decision, and no scan makes it for you.

If calcium shows, the disease is there and treatment starts

The other half of a CAC score is simpler. Calcium present means the disease is present. In Dr. Kedan’s words, then we know it’s there, and then we treat.

That is where he stopped on the episode, and it is where this post stops too. He did not walk through what treatment looks like, and nothing here should be read as a plan. What he did describe is how treatment gets measured once it starts. Most cardiology, he said, is chronic disease management: a patient arrives with a diagnosis, heart failure, coronary disease, an arrhythmia, and the work from there is managing it over time. Aging, he added, is a chronic disease, whatever you want to call it.

When you treat, the images change. Physiology changes and the anatomy reflects it. Because his scans are digital files, they can be stored in the chart, sent to the patient, and compared to the next one.

If you can store those images, give them to the patient or store them digitally, you can compare and you can see treatment effect.

He compared it to the gym: the 400-meter split, the bench press, the muscle you can watch grow. A treatment you can measure is a treatment you can judge. Mike’s suggestion was to use the ultrasound as the tracking tool between bigger tests, an ultrasound recheck every three or four months for someone with known buildup, and to save the full workup for when the picture changes. Dr. Kedan said that was exactly what he was about: seeing the change in physiology before you feel it.

The radiation ledger: ultrasound, CAC scan, CT and MRI

Mike raised the exposure question twice on the episode, once about contrast and once about the cumulative dose of repeated scans. Dr. Kedan’s answers sort the imaging types into a ledger you can carry into any appointment.

Ultrasound, the handheld device he brought to the set, uses no radiation and no contrast. Its limit is resolution. The coronary arteries are 3 to 5 millimeters across, smaller than the screen can resolve, so the probe reads the heart muscle those arteries feed rather than the arteries themselves. That gap is exactly what the CAC scan fills; the companion post above covers what the ultrasound can see.

The calcium scan is X-ray, low dose, no contrast. He did not put a number on the dose.

X-rays, CT scans and PET scans are ionizing radiation.

Ionizing radiation, what the patients would be getting with X-rays or PET scans, can damage cells and is associated with cancer risk. You don’t need any of that if you use ultrasound.

Can it add up? Mike asked whether frequent scanning amounts to a kind of poisoning. Dr. Kedan said you definitely can get too much if you have enough radiation, and gave the example of people treated for disease young who then get a CT scan every year from age 20 onward. Cancer survivors, he said, can develop what oncology calls second primaries, a new cancer decades after the first. Whether the treatments and the scans caused it, his honest answer was that we don’t know, and it is not helping them be healthier. He gave no safe annual limit, and this post will not invent one.

MRI is the separate line. Mike had described MRI contrast as a radioactive isotope; Dr. Kedan corrected him. The MRI itself is magnets, not radiation. The contrast agent, gadolinium, is generally well tolerated, but he said its long-term health implications are not fully known, and for some patients it is contraindicated: it would harm them. So MRI sits on a different ledger from the CT question, with its own line for contrast.

How this fits the Operation Fitness method

Mike’s own habits on the episode line up with the ledger. At 68, he asks for his pulse and blood pressure at every checkup and draws comprehensive blood work every four months. His reasoning is plain: skip the checkups and one day you may not wake up.

That is the same logic behind every Operation Fitness program. Mike’s rule is that you cannot get onto a longevity program until you have addressed your health issues first, and a heart nobody has imaged is an unaddressed issue. The programs are designed by Mike and delivered by his team, and the first step is the same for everyone. Tested, not guessed applies to your coronary arteries the same way it applies to your blood work.

Where to go from here

Watch the full conversation with Dr. Ilan Kedan on YouTube: Ep. 40, Heart Health with Portable Ultrasound.

See how testing comes first in every Operation Fitness program at /programs.

If you want a conversation about where a scan like this fits in your plan, request a consultation.