@dromar.eth

A calcium "CAC" score of zero is one of the most reassuring findings in preventive cardiology. But for South Asians, I do not think it should always be treated as the end of the cardiovascular risk conversation. And why CCTA has a place. CAC measures calcified plaque. It is useful, accessible, and often clinically helpful. But it does not directly answer whether non-calcified, or soft, plaque is present. That distinction matters. South Asians often develop cardiovascular disease earlier, at lower BMI, and with risk patterns that can be underestimated by generic thresholds. In selected patients, especially those with symptoms, premature family history, diabetes or insulin resistance, elevated ApoB, elevated Lp(a), or a story that does not fit the number, CAC=0 may still leave an important question open. That is where CCTA, AI-QCT, FFR-CT, and stress CMR enter the conversation. Not as blanket escalation, but as different tools for different biological questions. The point is not “CAC vs CCTA.” The point is: What biology are we trying to detect? This is the first piece in Zinda Futures, a series on how future-facing medicine needs to be calibrated for South Asian biology instead of simply layered onto population averages. Read the full piece: The Calcium Score Can Be Zero. The Plaque Risk May Not Be. https://blog.zinda.health/p/the-calcium-score-can-be-zero-the?r=1fp8g

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