Cardiometabolic Screening

What this screening includes

• Coronary Artery Calcium (CAC) score — a fast, low-dose CT that measures calcified plaque in your heart's arteries.
• CT Coronary Angiography (optional) — adds a contrast scan to see soft (non-calcified) plaque and any coronary vessel narrowing.
• Carotid Doppler ultrasound — measures the artery-wall thickness and any plaque in your neck arteries (no radiation).
• Liver shear-wave elastography — ultrasound that gauges liver stiffness and fat (no radiation).
• DEXA body composition — measures visceral (organ) fat and muscle at a very low dose.

What it is for & what it can find

A standard risk calculator estimates your heart risk from averages. These scans measure what is actually happening in your body, which can move you up or down the risk scale. A calcium score of zero, for example, is linked to a very low 10-year risk of a heart event and can support holding off on medication; a high score can justify starting it.

The liver and body-fat measures catch metabolic problems early — fatty liver and excess visceral fat are strong, and largely reversible, drivers of future diabetes and heart disease.

Benefits

• Gives quantitative, repeatable baselines you can track after lifestyle or medication changes.
• Mostly low- or no-radiation (ultrasound and DEXA use none or almost none).
• Can meaningfully change decisions — for example, whether to start a statin.
• Detects fatty liver and visceral fat while they are still reversible.

Limitations & things to consider

• The calcium score and CT angiogram use low-dose X-rays (roughly 1–3 mSv and 5–15 mSv respectively).
• A calcium score alone cannot see soft, non-calcified plaque — that is what the CT angiogram adds.
• Scans can reveal incidental findings that lead to further tests, cost or anxiety.
• Results guide risk; they are not a guarantee — a reassuring result does not remove all risk, and abnormal results are not a diagnosis.

Who should consider it

• Adults roughly 35–65 wanting a cardiometabolic baseline.
• Family history of early heart attack or stroke, or of high cholesterol.
• Metabolic syndrome, insulin resistance, pre-diabetes or an abnormal lipid panel.
• Anyone wanting to quantify and then track modifiable heart and metabolic risk.

References

Independently sourced and verified (September 2026). Links open the original publications.

1. Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease. Circulation. 2019;140(11):e596–e646. https://doi.org/10.1161/CIR.0000000000000678
2. McClelland RL, Jorgensen NW, Budoff M, et al. 10-Year CHD Risk Prediction Using Coronary Artery Calcium and Traditional Risk Factors (MESA). J Am Coll Cardiol. 2015;66(15):1643–1653. https://doi.org/10.1016/j.jacc.2015.08.035
3. Agatston AS, Janowitz WR, Hildner FJ, et al. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 1990;15(4):827–832. https://doi.org/10.1016/0735-1097(90)90282-T
4. SCOT-HEART Investigators. Coronary CT Angiography and 5-Year Risk of Myocardial Infarction. N Engl J Med. 2018;379(10):924–933. https://doi.org/10.1056/NEJMoa1805971
5. Touboul PJ, Hennerici MG, Meairs S, et al. Mannheim Carotid Intima-Media Thickness and Plaque Consensus (2004-2006-2011). Cerebrovasc Dis. 2012;34(4):290–296. https://doi.org/10.1159/000343145
6. Rinella ME, Lazarus JV, Ratziu V, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature (MASLD). J Hepatol. 2023;79(6):1542–1556. https://doi.org/10.1016/j.jhep.2023.06.003
7. Neeland IJ, Ross R, Després JP, et al. Visceral and ectopic fat, atherosclerosis, and cardiometabolic disease: a position statement. Lancet Diabetes Endocrinol. 2019;7(9):715–725. https://doi.org/10.1016/S2213-8587(19)30084-1

This information sheet is for education and to help you choose appropriate screening. It is not a diagnosis or medical advice. Screening tests have benefits and harms; discuss your personal situation with your doctor. All studies are performed and interpreted by specialist or subspecialist radiologists (HPCSA-compliant; radiation kept As Low As Reasonably Achievable).