A recent Wall Street Journal article raised a common question: Should you get a heart scan before starting a statin? It highlighted the role of a coronary artery calcium (CAC) score, a quick, noninvasive test that helps assess heart disease risk. We agree it’s an important tool. But as cardiologists, we also know what a calcium score can miss and when more advanced imaging is worth considering. Here’s how to think about heart scans, plaque, and statin decisions based on your individual risk.
A coronary artery calcium score measures calcified plaque in the arteries and helps guide statin decisions, but it cannot detect non-calcified ‘soft’ plaque, which can be equally dangerous.
A CAC scan takes less than 10 minutes, requires no dye or IV, and uses a low dose of radiation. It looks for calcium deposits in your coronary arteries, and the amount of calcium it finds correlates strongly with your risk of a future heart attack or stroke.
For patients sitting in the middle ground, not clearly low risk and not clearly high risk, a calcium score can be the deciding factor in whether to start a statin. If the score is zero, we might hold off. If it’s elevated, we act. The 2018 cholesterol guidelines from the American Heart Association and the American College of Cardiology formally recognize this approach for patients where the statin decision is uncertain.
A calcium score only detects calcified plaque, the kind that has already hardened over time. But there’s another type of plaque called non-calcified, or “soft,” plaque that doesn’t show up on a standard CAC scan at all. And soft plaque can be just as dangerous, sometimes more so, because it’s more prone to rupturing and causing a sudden heart attack.
A patient can have a calcium score of zero and still have meaningful plaque in their arteries. We see this clinically. It’s not rare.
This doesn’t mean the calcium score is a bad test. It means it’s one part of a larger picture. And for some patients, particularly younger patients, women, and those with strong family histories, relying on it alone can leave real risk undetected.
At Virginia Cardiovascular Specialists, we have access to AI-enhanced coronary CT angiography, a more advanced imaging approach that detects and measures both calcified and non-calcified plaque. Our next-generation scanner produces detailed images of the coronary arteries, and artificial intelligence helps us analyze plaque composition in a way that simply wasn’t possible a few years ago.
That means we can find soft plaque that a standard calcium score misses, characterize what type of plaque is present and how stable it is, and for patients already on a statin, track whether the plaque is actually changing over time. Treatment becomes something we can measure rather than assume.
VCS has been caring for patients in Richmond and Central Virginia for nearly 50 years, and a commitment to innovation in cardiac imaging has been central to that work since we introduced cardiac CT in 2002. As an independently owned practice, our clinical decisions are made entirely around the patient, not hospital system protocols. Our CT Department holds a three-year reaccreditation from the Intersocietal Accreditation Commission (IAC) in Vascular CTA, Coronary CTA, and Coronary Calcium Scoring, an independent confirmation that our imaging meets the highest standards in the field.
Since that article came out, our team has had a number of these conversations. Here are the questions we hear most often.
“My calcium score was zero. Does that mean I’m fine?”
Not necessarily. A score of zero means no calcified plaque was detected, and that does matter. But it doesn’t rule out soft plaque. If you have a strong family history of heart disease, other risk factors, or symptoms, a zero score doesn’t mean the conversation is over. It means we look closer.
“I’m already on a statin. Why would I need a scan?”
Because now we can actually see whether it’s working. AI-enhanced imaging allows us to track changes in plaque volume and composition over time. If your treatment is effective, we’ll see it. If it isn’t, we can adjust. For many patients, that kind of objective feedback changes how they think about their medication.
“I’m in my 40s. Is it too early?”
It’s a good time to look. Atherosclerosis, the buildup of plaque in the arteries, develops over decades, often without any symptoms. Identifying it early gives us more options to slow or reverse it. Waiting for symptoms means waiting until the disease has already progressed significantly.
“Does insurance cover this?”
A standard calcium score screening at VCS typically is about $160 and is often paid out of pocket. Coverage for more advanced imaging varies. Our team can help you understand your options when you call.
Cardiac imaging for preventive purposes isn’t right for everyone. It tends to be most useful for patients who:
The best first step is a conversation with your cardiologist or primary care provider about whether this type of imaging makes sense for your specific situation.
If your scan results point toward a need for further evaluation or treatment, VCS has every cardiovascular subspecialty in-house, so you won’t be sent elsewhere.
Preventive imaging is most valuable when pursued proactively, before symptoms develop. Appointments for preventive cardiac imaging at VCS are currently being scheduled several months in advance, and we encourage patients considering this type of evaluation to contact our office sooner rather than later.
Our team is happy to answer your questions and help you decide if a scan is right for you.
Locations across Richmond and Central Virginia
About the Author
Dr. William L. Coble, Jr. is a board-certified cardiologist at Virginia Cardiovascular Specialists, where he has cared for patients in the Richmond region. He was named a 2026 Richmond Magazine Super Star Doctor and a 2026 Virginia Top Doctor. Dr. Coble holds board certifications in Internal Medicine, Cardiovascular Disease, and Nuclear Cardiology. He specializes in Cardiac Computed Tomography, Nuclear Cardiology, and Sports Cardiology.
Virginia Cardiovascular Specialists has served patients across Central Virginia for nearly 50 years, with nine locations throughout the Richmond metro area. Learn more at vacardio.com.
Published: April 14, 2026
Medically reviewed by board-certified cardiologists at Virginia Cardiovascular Specialists
Published April 14, 2026