The Soft Plaque Paradox:
Why a "Zero" Score Isn't Always Safe
Standard Calcium Scores only see the "Old Damage." They completely miss the new, volatile plaque that causes the majority of heart attacks.
Many men walk out of their executive physical high-fiving their doctor because they got a Calcium Score of 0. Yet, they still have "invisible" plaque building up in their artery walls. This is called Soft Plaque.
| Calcified Plaque (What the Scan Sees) |
Soft Plaque (What the Scan Misses) |
|
| Analogy | The Scar. Hard, stable, and old. It's like concrete. | The Pimples. Soft, inflamed, and fragile. It's like a blister ready to pop. |
| Risk Profile | Paradoxically more stable. It is less likely to suddenly rupture. | Highly Volatile. If this "blister" bursts, it forms a clot instantly, causing a heart attack. |
| Detection | Standard CT Calcium Score ($100 test). | Requires CCTA with AI Analysis OR Advanced Biomarkers. |
Why Your Doctor Misses It
The standard of care is designed to find late-stage disease. A Calcium Score looks for calcium deposits. But plaque doesn't start as calcium. It starts as cholesterol and inflammation getting trapped in the wall of your artery (the endothelium).
It can stay in this "Soft" state for years. During this time, your Calcium Score will be Zero, but your actual risk could be critically high.
The House Analogy
Think of your arteries like a house.
- Soft Plaque is Termite Damage: You can't see it from the outside. The structure looks fine, but the wood is being eaten away inside the walls. This is where the house collapses.
- Calcified Plaque is a Metal Brace: When the body realizes the wall is weak, it sends calcium to "harden" the area. It’s a patchy repair job. It’s ugly, but it's actually trying to hold the wall up.
The problem: Standard medicine only looks for the Metal Braces. If you have Termites but no Braces yet, they tell you your house is perfect.
You don't need to wait for a heart attack or a calcium deposit to know if you are at risk. You can measure the health of the "Wall" itself.
This is why we focus on Endothelial Health. By measuring inflammation and vessel function, we can see if the environment is right for Soft Plaque to form, long before it shows up on a scan.
Common Questions
Is a Calcium Score of 0 meaningless?
No, it's still good news. It means you don't have old, hardened disease. But it does NOT mean you have no plaque at all. It just means you don't have calcified plaque.
How do I know if I have Soft Plaque?
The definitive test is a CCTA (CT Angiogram) with AI analysis, like the Cleerly scan. However, checking your endothelial biomarkers (the health of your vessel lining) gives you a leading indicator of risk.
Can Soft Plaque be reversed?
Yes. Soft plaque is much easier to regress than hard calcium. Because it is made of lipids (fats) and inflammation, aggressive lipid lowering and endothelial repair can stabilize and shrink these plaques.