# Coronary Artery Calcium (CAC) CT Scan - Clinical Longevity Review & Consensus Audit

> **Consensus Verdict**: Coronary Artery Calcium (CAC) scoring via non-contrast low-dose cardiac CT is the single most powerful prognostic tool for stratifying asymptomatic individuals and quantifying personalized coronary atherosclerotic burden. Landmark data from the MESA cohort (Nasir 2015) demonstrates that a CAC score of zero confers a 10-to-15-year cardiovascular "warranty" with annualized event rates <0.1%, justifying statin de-escalation in discordant clinical presentations, whereas CAC > 100 or > 75th percentile demands aggressive lipid-lowering and endothelial protection.

## 1. Executive Summary & Scores
- **Longevity Evidence Score**: **95/100**
- **Evidence Quality Tier**: **gold**
- **Human Clinical Evidence Strength**: 96/100
- **Primary Longevity Classification**: other
- **Safety Margin Score**: 92/100 (Higher is safer)
- **Time Burden**: ~10 minutes/day
- **Estimated Monthly Cost**: clinical
- **Adherence Friction**: 2/10 (Lower is easier to sustain)

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## 2. Biological Mechanisms of Action
Low-dose non-contrast cardiac CT quantifies calcified coronary artery plaque to produce an Agatston score.

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## 3. Canonical Longevity Vector Impacts (The 8 Longevity Pillars)
- **Heart Health & Endothelial Function**: **0/100** [Rank #127 of 133 in Heart] - Effect: Surveillance Only
    - Mechanism: Diagnostic surveillance tool; quantifies objective biomarkers and anatomical status for heart health without directly inducing biochemical adaptation.
- **Brain Longevity & Neuroprotection**: **0/100** [Rank #135 of 141 in Brain] - Effect: Surveillance Only
    - Mechanism: Diagnostic surveillance tool; quantifies objective biomarkers and anatomical status for brain longevity without directly inducing biochemical adaptation.
- **Metabolic Flexibility & Glycemic Control**: **0/100** [Rank #115 of 129 in Metabolic] - Effect: Surveillance Only
    - Mechanism: Diagnostic surveillance tool; quantifies objective biomarkers and anatomical status for metabolic health without directly inducing biochemical adaptation.
- **Cancer Defense & DNA Repair**: **0/100** [Rank #95 of 120 in Cancer Defense] - Effect: Surveillance Only
    - Mechanism: Diagnostic surveillance tool; quantifies objective biomarkers and anatomical status for cancer defense without directly inducing biochemical adaptation.
- **Endocrine & Anabolic Balance**: **0/100** [Rank #75 of 120 in Endocrine] - Effect: Neutral
    - Mechanism: Diagnostic imaging dedicated to coronary vasculature; zero endocrine modulation.
- **Chronic Inflammation Reduction**: **0/100** [Rank #124 of 126 in Inflammation] - Effect: Surveillance Only
    - Mechanism: Diagnostic surveillance tool; quantifies objective biomarkers and anatomical status for chronic inflammation without directly inducing biochemical adaptation.
- **Bone Density & Connective Matrix**: **0/100** [Rank #109 of 142 in Bone Matrix] - Effect: Surveillance Only
    - Mechanism: Diagnostic surveillance tool; quantifies objective biomarkers and anatomical status for bone density without directly inducing biochemical adaptation.
- **Cellular Longevity & Autophagy**: **0/100** [Rank #130 of 131 in Cellular] - Effect: Surveillance Only
    - Mechanism: Diagnostic surveillance tool; quantifies objective biomarkers and anatomical status for cellular longevity without directly inducing biochemical adaptation.

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## 4. Practical Protocol & Administration Guidelines
- **Standard Clinical Dosage**: Standard dose
- **Recommended Timing**: Infrequent / Diagnostic Milestone
- **Administration Type**: Behavioral / Compound
- **Recommended Biomarkers to Monitor**: heart_health, calmness, bone_density, testosterone, cancer_defense, brain_longevity

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## 5. Safety, Contraindications & Drug Interactions
- **Contraindications**: Pregnancy (ionizing radiation), Known prior coronary revascularization/stenting (renders CAC calculation uninterpretable due to metal artifact)
- **Safety Profile**: safe - Minimal ionizing radiation exposure (0.7–1.0 mSv, comparable to mammography or 3 months of natural background radiation)

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## 6. Peer-Reviewed Human Clinical Trials & Key PMIDs
1. **Coronary Artery Calcium (CAC) CT Scan for Longitudinal Longevity Risk Stratification** 
   - Link: https://pubmed.ncbi.nlm.nih.gov/
2. **Impact of coronary artery calcium scanning on patient adherence and lifestyle modification** [PMID: 24332243]
   - Link: https://pubmed.ncbi.nlm.nih.gov/24332243/
3. **Ten-Year Outcomes in Patients With Zero Coronary Artery Calcium (MESA)** [PMID: 26450465]
   - Link: https://pubmed.ncbi.nlm.nih.gov/26450465/
4. **Coronary Artery Calcium Scoring for Long-Term Statin Allocation** [PMID: 32674768]
   - Link: https://pubmed.ncbi.nlm.nih.gov/32674768/
5. **Warranty period of a normal coronary artery calcium score for predicting cardiovascular events (MESA Study)** [PMID: 26471780]
   - Link: https://pubmed.ncbi.nlm.nih.gov/26471780/

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## 7. Canonical Citation & Web Verification
- **Official Web Review**: [Coronary Artery Calcium (CAC) CT Scan on LongevityReviews](https://longevityreviews.org/modalities/cac-calcium-scan)
- **Last Evidence Calibration**: 2026-09-09
- **Review Policy**: 0% sponsored placements, independent peer-reviewed consensus.