@rjd
Any CAC score above zero indicates the presence of calcified plaque, which reflects a later stage of atherosclerosis. At the same time, a CAC of zero doesn’t guarantee there’s no plaque at all, it simply means there’s no calcified plaque; soft plaque may still be present.

I was replying to @pattiel because she mentioned her CAC score was 24. Like her, I had a small reading of 38 before considering HRT. At first, not knowing the full scope of assessment, I thought my chances of being on HRT were very slim due to having advanced atherosclerosis. But after evaluations by two cardiologists, I realized they consider many factors, including but not necessarily limited to: family history and genetic markers such as Lp(a), metabolic health, blood pressure, lipid panel (LDL-c or ApoB), CAC score and other heart conditions. All of the information is used to estimate overall cardiovascular risk, with or without HRT.

So to my understanding, neither a low nor a high CAC score is an automatic stop. A very high CAC score will certainly shift the conversation and influence the discussion to some degree. Ultimately, the score must be interpreted in the context of the complete picture of cardiac health.

@pattiel mentioned she has a patent foramen ovale (PFO). I’m not fully familiar with the specifics, but I suspect her cardiologist was considering potential increased clot risk if she uses HRT. Other conditions, like Afib, also increase clotting risk and may influence HRT decisions in some cases.