Coronary Calcium Score: Now What Do I Do?

You got a number that scared you more than any lab result ever has. Here's what it actually means — and what to do next.

Author	Bishnu Subedi, MD, FACC
Category	Health / Preventive Cardiology
Read time	~4 minutes
One-line takeaway	A calcium score is information, not a verdict — and there's a clear next step for every range.

The Big Idea

Your Coronary Artery Calcium (CAC) score measures hardened plaque in your heart's arteries, not whether you're blocked or in danger today. Written by a board-certified cardiologist, this book turns one confusing number into a clear, evidence-based action plan — covering medications, diet, exercise, and the hidden factors (like vitamin D or thyroid disease) that can skew your score.

Key Takeaways

Concept	What It Means	Apply It This Week
The Agatston Score	The raw number (0 to 1,000+) quantifying calcified plaque in your arteries.	Find your score's age/sex percentile, not just the raw number.
Power of Zero	A score of 0 predicts very low near-term risk — but isn't a lifetime guarantee.	If your score is 0, ask your doctor when to rescan (usually 5–10 years).
Score ≠ Blockage	CAC shows plaque presence, not whether an artery is actually narrowed.	Don't request a stent or bypass based on CAC alone — ask what test would actually confirm blockage.
Statin Threshold	Guidelines favor statin therapy once CAC is above 0, and strongly above 100.	Bring your exact score and LDL number to your next appointment.
Non-Calcified Plaque	Soft, unstable plaque doesn't show up on a CAC scan — even at a score of 0.	Keep tracking LDL/apoB and lifestyle habits even with a reassuring score.

The Framework, Visually

Low-Dose CT Scan

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Agatston Score Calculated

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0 Very Low	1–99 Mild	100–399 Moderate	400+ Severe
Lifestyle only; rescan in 5–10 yrs	Statin discussion; tighten diet + exercise	Statin + risk-factor control; cardiology follow-up	Aggressive lipid-lowering; treat like existing heart disease

Do This Today

• Write down your exact score and its age/sex percentile — not just "high" or "low."
• Ask your doctor directly: "Based on my score, should I be on a statin?"
• Get an LDL/apoB check if you haven't had one in the last year.
• Book a follow-up scan date now (5–10 years out if your score is 0, sooner if elevated).
• Skip the stent conversation unless a separate test has shown an actual blockage.

"A calcium score is useful, actionable information — not a verdict."

— Bishnu Subedi, MD, FACC

Go Watch

The Agatston Score → linked to: "Mayo Clinic Minute: How a coronary calcium scan assesses heart attack risk" (Mayo Clinic)

Power of Zero → linked to: "Power of Zero: Coronary Artery Calcium Journey — Screening Test to Decision Tool" (Dr. Khurram Nasir, HMH Grand Rounds)

Score ≠ Blockage → linked to: "Coronary Artery Calcium Score (CAC) — Can It Predict A Heart Attack?" (Talking with Docs)

Get the Book

If you've ever stared at your own calcium score wondering what to do next, this is the book to hand your future self — 21 chapters of straight answers, myth-busting tables, and questions to bring to your own cardiologist.

Buy on Amazon

Go Deeper

• American College of Cardiology (CardioSmart): Coronary Artery Calcium Scoring
• Cleveland Clinic: Calcium Score Test Explained
• Harvard Health: My Calcium Score Is Over 2,000 — What's Next?

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Beyond Weight Loss: GLP-1 Medicines and Your Heart

Beyond Weight Loss: What GLP-1 Drugs Actually Do to Your Heart

Is your semaglutide shot protecting your heart — or just shrinking your waistline? A cardiologist, not a coach, breaks down what the trials really show.

Author	Dr. Bishnu Subedi, board-certified cardiologist
Category	Health & Medicine / Cardiology
Read time	~4 minutes
One-line takeaway	GLP-1 medicines have real, trial-proven heart benefits — but they don't replace your other heart medications.

The Big Idea

Drugs like semaglutide and tirzepatide weren't just built to shrink you — large cardiovascular trials now show they cut heart attacks, strokes, and heart failure symptoms, and some of that benefit happens independently of weight loss itself. But the evidence is uneven: some claims are proven, some are promising, and some are still theory. Subedi's whole book is a filter for telling those apart.

Key Takeaways

Concept	What It Means	Apply This Week
The SELECT Trial	In 17,604 people with heart disease and obesity (no diabetes), semaglutide cut major cardiac events by 20% — and the benefit didn't track cleanly with how much weight people lost.	Stop judging the drug's success only by the scale — ask your doctor what your other risk markers are doing.
STEP-HFpEF	In patients with obesity and a specific type of heart failure (HFpEF), semaglutide improved symptoms and physical function.	If you have diagnosed heart failure, ask specifically whether this trial applies to your type.
Lp(a)	A genetically inherited, LDL-like particle that raises heart risk — and doesn't budge no matter how much weight you lose on a GLP-1.	Ask for a one-time Lp(a) blood test if you've never had one — it's usually a single lifetime check.
Muscle Preservation	Up to a quarter to nearly 40% of the weight lost on these drugs can be muscle, not fat, especially without intervention.	Add two resistance-training sessions and prioritize protein at every meal.
The Evidence Ladder	Subedi's core framework: sort every claim about these drugs into Proven, Promising, or Still Theory before you believe it.	Next time you see a bold GLP-1 headline, ask "which rung of the ladder is this actually on?"

The Evidence Ladder — Visualized

GLP-1 / GIP Medicine (semaglutide, tirzepatide)

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PROVEN — backed by large, randomized cardiovascular outcomes trials
SELECT (MACE −20%)  •  STEP-HFpEF (heart failure symptoms)  •  SURMOUNT-OSA (sleep apnea severity)

PROMISING — positive signal, but earlier or narrower data
SUMMIT (heart failure w/ preserved ejection fraction, broader population)  •  FLOW (kidney protection in diabetes)

STILL THEORY — plausible mechanism, not yet proven in people
Direct anti-inflammatory effect on artery walls  •  Long-term dementia risk reduction

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Your statin, BP medicine, and anticoagulant still do their own job — the GLP-1 doesn't replace them.

Do This Today

• Ask your doctor for a one-time Lp(a) blood test if you've never had one.
• Don't stop your statin, blood pressure medicine, or blood thinner just because you started a GLP-1 — confirm with your prescriber first.
• Book two resistance-training sessions this week and hit a protein target at every meal to protect muscle.
• Bring a written "Know Your Numbers" list (weight, blood pressure, A1c, LDL, Lp(a)) to your next appointment.
• Before trusting a headline about these drugs, ask which rung of the Evidence Ladder it's actually standing on.

"Know what the evidence proves, what it merely promises, and what's still just theory." — paraphrased from Dr. Bishnu Subedi's framing in Beyond Weight Loss

Watch & Go Deeper

SELECT Trial → linked to: "The SELECT Trial — Semaglutide's Projected Cardiovascular Benefit Explained" (YouTube)

Lp(a) → linked to: "Explaining Lipoprotein (a) | Preventive Cardiology" (Ann Marie Navar, MD)

Muscle Preservation → linked to: "Doctor Explains How to Workout On GLP-1s to Prevent Muscle Loss" (YouTube)

Get the Book

If you or someone you love is taking, considering, or just curious about a GLP-1 or GIP medicine, this is the rare guide written by a cardiologist rather than a weight-loss coach — evidence-first, drug by drug, condition by condition, with trackers you can actually bring to your appointments.

Buy on Amazon

Original Sources

• American College of Cardiology — full SELECT trial breakdown
• Cleveland Clinic newsroom — original SELECT trial announcement
• Dr. Bishnu Subedi's UPMC provider profile & credentials

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