Cardiovascular disease is the number one killer for both men and women in the United States. [1] Yet some people who experience serious cardiac events have minimal to no symptoms beforehand and no indication from routine testing that heart health issues were developing. [2]
So, what are physicians missing? Many traditional cardiovascular assessments focus on estimating risk rather than identifying disease itself. While cholesterol levels, blood pressure readings, family history, and risk calculators all provide valuable information, they are ultimately proxies for what clinicians are trying to understand: the health of your coronary arteries.
CT coronary angiography (CTCA) offers a different approach. Rather than estimating the likelihood of coronary artery disease, CTCA allows physicians to directly visualize the coronary arteries and identify plaque buildup before it causes symptoms or leads to a cardiac event, such as a heart attack.
What is CT coronary angiography?
CT coronary angiography, often abbreviated as CTCA, is a specialized heart CT scan that produces highly detailed images of the coronary arteries.
During the scan, intravenous contrast dye is used to visualize blood flow through the arteries that supply oxygen to the heart. Advanced CT imaging then creates a three-dimensional view of the coronary circulation.
This allows physicians to identify:
Calcified plaque
Soft (non-calcified) plaque
Narrowing of the coronary arteries (stenosis)
Early signs of atherosclerosis
Certain congenital or anatomical abnormalities
Unlike many traditional heart screening tools, CTCA allows clinicians to directly examine the arteries themselves rather than infer risk based on indirect measurements.
What can a CTCA detect that other tests can't?
One of the biggest advantages of CT coronary angiography is its ability to identify plaque before it causes symptoms or long-term damage.
Many other cardiovascular tests answer different questions. For instance, a cholesterol panel (or lipid profile) measures circulating lipids (fats) in the bloodstream. An electrocardiogram (ECG) evaluates the electrical activity of the heart in real time. A stress test assesses how well the heart functions during exertion.
CTCA, however, evaluates the coronary arteries directly. This means it can identify both calcified and non-calcified plaque, even in people who feel completely healthy.
This is what sets this test apart from others. Plaque often builds up silently over decades, so by the time classic heart attack symptoms such as chest pain, shortness of breath, or exercise intolerance occur, coronary artery disease is already well underway. CTCA can identify these changes before symptoms develop and, in some cases, before abnormalities become apparent on traditional testing.
Can you have normal cholesterol and still have plaque?
Yes, you absolutely can. One of the most common misconceptions in preventive cardiology is that normal cholesterol levels automatically equate to healthy arteries.
While cholesterol is an important risk factor, it doesn’t directly identify the presence of coronary artery disease. Some people with relatively normal lipid levels still develop significant plaque buildup. Others with elevated cholesterol may have little detectable plaque.
This is one reason CTCA has become increasingly valuable in preventive health and longevity medicine. Instead of estimating risk from laboratory values alone, clinicians can evaluate whether plaque buildup is occurring in the arteries. This data can help inform clinicians on next steps to lower the risk of disease and future cardiac events.
What's the difference between a CTCA and a CAC scan?
CTCA and coronary artery calcium (CAC) scoring are both valuable tools, but they provide different information. A CAC scan measures calcified plaque within the coronary arteries and generates a calcium score that reflects overall plaque burden.
A CTCA provides a much more detailed evaluation of coronary anatomy and can identify:
This distinction matters because a calcium score of zero doesn’t necessarily mean plaque is absent. Soft, non-calcified plaque often develops before calcification occurs and may not be detected by a CAC scan.
In some cases, people with a CAC score of zero may still have clinically significant plaque visible on CTCA.
Instead of thinking of CTCA vs. CAC scan as an either-or decision, it’s best to view them as screenings that provide complementary information, especially when that information is interpreted within the broader context of an individual's cardiovascular risk profile.
Not everyone needs a CTCA. But, it can be particularly valuable for people who want a more precise understanding of their cardiovascular health. Those who may benefit from this screening include:
Adults with a family history of premature heart disease
Individuals with elevated ApoB or Lp(a)
People with metabolic risk factors, such as insulin resistance
High-performing professionals exposed to chronic stress
Individuals with borderline or intermediate cardiovascular risk
People interested in proactive longevity-focused health screening
Research has shown that prolonged job-related stress and long working hours may contribute meaningfully to cardiovascular risk, making direct assessment of coronary health particularly relevant for many executives and high-performing professionals. [3]
Is the procedure safe?
A CTCA is considered a non-invasive procedure and it only takes a few minutes to complete.
Some people may have their heart rate lowered temporarily with medication to optimize image quality.
You will be exposed to a small amount of radiation, and the contrast dye is not appropriate for everyone, particularly certain patients with kidney disease or contrast allergies. [4]
For most healthy adults, however, the risks are relatively low and are often outweighed by the value of the information obtained.
When it comes to deciding whether or not to do this procedure, consider partnering with your care team to make an informed decision that takes your health and goals into consideration.
A real-world example of why CTCA matters
Consider a woman in her fifties who came to Biograph after experiencing chest discomfort several weeks earlier. She had already undergone a traditional cardiac evaluation, including emergency assessment and stress testing, neither of which identified an immediate concern.
Still, she wanted a more comprehensive understanding of her cardiovascular health, so she elected to undergo coronary CT angiography as part of her Biograph cardiovascular assessment.
The scan revealed severe narrowing in a major coronary artery, a finding that had not been detected through prior functional testing alone. Armed with that information, her care team coordinated timely specialist follow-up and treatment before a more serious cardiac event occurred.
Her experience highlights an important reality: different cardiovascular tests answer different questions. Stress testing evaluates how the heart performs under exertion but may fail to detect significant stenosis in some cases. However, CT coronary angiography allows clinicians to actually see the extent and severity of plaque buildup and determine the significance of any coronary artery disease present.
How does Biograph use CTCA?
At Biograph, CTCA and CAC scans are included with a Black Membership. But the value of these tests doesn't come from imaging alone. Their findings are interpreted within the broader context of your cardiovascular health, including:
Advanced blood biomarkers such as ApoB and Lp(a)
Coronary artery calcium scoring
Body composition analysis
Blood pressure assessment
Physician-led cardiovascular review
This multi-layered approach helps create a more complete understanding of cardiovascular health than any single test alone.
The bottom line
Traditional heart screening tools estimate cardiovascular risk. While that information is valuable, the CT coronary angiography offers something more powerful: the ability to spot the beginning or progression of disease in the arteries.
As preventive cardiology continues to evolve, CTCA is becoming an increasingly important tool for identifying plaque before symptoms develop and helping individuals make more informed decisions about their long-term health.
If you want to know whether your arteries are healthy, not just whether you might be at risk, CT coronary angiography may be worth discussing with your physician.
Commonly asked questions about CT coronary angiography
What does CT coronary angiography show?
CTCA provides detailed images of the coronary arteries and can identify calcified plaque, soft plaque, narrowing of the arteries, and early coronary artery disease.
What’s the difference between a CTCA and a CAC scan?
A CAC scan measures calcified plaque only, while CTCA evaluates the coronary arteries directly and can detect both calcified and non-calcified plaque.
Can I have plaque with a calcium score of zero?
Yes. Soft plaque may be present even when a calcium score is zero. CTCA can detect non-calcified plaque that CAC scans cannot.
Is CT coronary angiography invasive?
No. CTCA is considered a non-invasive cardiac imaging test. It uses CT imaging and intravenous contrast but doesn’t require surgery or catheterization.
Can CTCA detect heart disease before symptoms appear?
Yes. One of the major advantages of CTCA is its ability to identify plaque and coronary artery disease before symptoms develop.
Does Biograph include CT coronary angiography?
CT coronary angiography is included as part of Biograph's Black Membership cardiovascular assessment alongside CAC scoring, advanced biomarkers, fitness testing, and physician-led review.
Dr. Michael Doney is Biograph’s Executive Medical Director, with over 20 years of experience leading clinical care and advancing a more proactive, data-driven approach to medicine.
Clinical references
Centers for Disease Control and Prevention. Heart Disease Facts. CDC. Published October 24, 2024. https://www.cdc.gov/heart-disease/data-research/facts-stats/index.html
Reinier K, Dizon B, Chugh H, et al. Warning symptoms associated with imminent sudden cardiac arrest: a population-based case-control study with external validation. The Lancet Digital Health. 2023;5(11). doi:10.1016/s2589-7500(23)00147-4
Pega F, Náfrádi B, Momen NC, et al. Global, regional, and national burdens of ischemic heart disease and stroke attributable to exposure to long working hours for 194 countries, 2000–2016: A systematic analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury. Environment International. 2021;154(106595):106595. doi:10.1016/j.envint.2021.106595
National Kidney Foundation. Contrast Dye and Your Kidneys. https://www.kidney.org/kidney-topics/contrast-dye-and-kidneys
