A Clearer Picture of Your Heart Health — Before a Problem Develops

By Neil Agrawal, M.D.

Most people know that high cholesterol, high blood pressure and family history are warning signs for heart disease. But what if your numbers look fine and you still have significant buildup in your arteries? Until recently, that gap in the picture was difficult to fill. A newer imaging approach available at Saint Francis Heart and Vascular Institute is changing that.
 

The Limits of Traditional Risk Assessment

For years, coronary artery calcium scoring has been one of the most useful tools for assessing cardiovascular risk. It's well-validated, widely available and genuinely helpful — but it has one important limitation: it only detects calcified plaque. It cannot see softer, non-calcified plaque that can develop earlier in the disease process and may contribute to future heart attacks.

That means some patients with significant plaque buildup may appear lower risk than they actually are — and some patients with reassuring calcium scores may still benefit from a closer look.
 

A More Complete View

Coronary CT angiography — or CCTA — allows physicians to see both the inside of the coronary arteries and the arterial wall itself. When paired with advanced plaque-analysis software, CCTA can identify and characterize total plaque burden, including calcified, non-calcified and higher-risk plaque features.

The result is a more precise, personalized picture of cardiovascular risk — one grounded in what's actually happening in the arteries, not just in traditional risk calculations.
 

What This Means for Treatment Decisions

That additional information can meaningfully change the conversation between a patient and their care team. For example:

• A patient with low or borderline calculated risk but significant plaque burden may benefit from earlier or more intensive preventive therapy — lifestyle changes, lipid-lowering medication or both
• A patient with reassuring imaging findings may be able to avoid unnecessary escalation of treatment, with confidence backed by direct anatomic evidence

This kind of precision is particularly valuable for patients with symptoms suggestive of coronary disease, intermediate risk, a strong family history of premature heart disease, or cases where traditional risk scores and clinical concern don't seem to align.
 

Now Available — and Increasingly Covered

CCTA-based plaque analysis is now offered at Saint Francis Heart and Vascular Institute as part of our commitment to precision cardiovascular prevention. Medicare coverage for selected indications began in late 2024, making this technology more accessible than ever for patients who may benefit.

If you have concerns about your heart health — or risk factors that haven't fully explained how you feel — talk to your provider about whether a CCTA evaluation makes sense for you. Getting a clearer picture today could make all the difference tomorrow.