Written by: Dr Ranjan Shetty
4 min readMay 19, 2026 05:14 PM IST
First published on: May 19, 2026 at 11:00 AM IST
A 30-year-old man came to see me with his CT calcium scan report, a non-invasive screening method that shows calcium deposits in the heart’s arteries, which eventually lead to plaque and blockage. His score was zero, which means very low risk. “My stress test and my echocardiogram are normal. I’ve lost around 15 kg by fasting and walking every day for an hour. But I am getting slight chest discomfort that is random and does not last long. Is something clogging my arteries,” he asked me, bewildered and worried.
The concern reflects a growing question among younger adults who are proactively screening for heart disease: if all tests appear normal, can there still be hidden risk? In ten per cent of cases like my young patient, it can. My own research has shown that this group harbours non-calcified or “soft” plaques that do not show up on a calcium scan. These softer plaques are less stable than calcified plaques and are more prone to rupture. Plaque rupture can trigger clot formation and lead to a heart attack. My patient underwent a CT angiogram, which uses a contrast dye injection, to detect soft plaque.
How to spot hidden risks?
While a coronary calcium scan and a CT coronary angiogram are both advanced heart imaging tools, they serve different purposes. A calcium scan is primarily a screening test that detects calcified plaque deposits in the coronary arteries and generates a calcium score that helps estimate long-term cardiovascular risk. A CT coronary angiogram, by contrast, provides a much more detailed picture of the arteries themselves and can reveal narrowing, blockages, and even soft, non-calcified plaque that may not show up on a standard calcium score test.
Who is at risk of soft plaque?
This risk of soft plaques is seen more often in people with diabetes, obesity and smoking history, as these groups are more likely to develop early-stage plaque that has not yet calcified. My patient figured in the obese category before he lost weight.
I looked at his lipid profile. His lipoprotein(a) or sticky cholesterol was 10, which is considered favourable, while ApoB or Apolipoprotein B (which is the primary protein found in low density lipoprotein or LDL cholesterol and allows it to circulate in the bloodstream) was 89. This is considered optimal. But it was his LDL reading that surprised me. It was 113 mg/dL, much above the aggressive preventive target many cardiologists recommend for higher-risk patients. Now LDL targets have been revised to 55 mg/dL or lower.
How to treat soft plaque?
We put him on high-dose statins. Beyond lowering LDL cholesterol, statins help stabilise softer plaques by promoting calcification and reducing inflammation. This process lowers the likelihood of plaque rupture and significantly reduces heart attack risk.
Brief, random discomfort without radiation — particularly when stress testing and echocardiography are normal — is often linked to non-cardiac causes such as muscle strain, acid reflux or anxiety. Still, if concern remains, experts say further evaluation through CT coronary angiography can provide definitive reassurance.
The larger lesson is this: a zero-calcium score is excellent news but in younger adults it does not completely exclude early soft plaque. When risk factors such as obesity, diabetes or smoking are present, looking beyond the calcium score can sometimes reveal the fuller picture.
(Dr Shetty is the lead cardiologist and medical director, Sparsh Hospital, Bengaluru)
The concern reflects a growing question among younger adults who are proactively screening for heart disease. (Source: Pexels) 
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