CAC Scan — Coronary Artery Calcium

A Coronary Artery Calcium (CAC) scan is a low-dose CT scan that measures calcified plaque in the coronary arteries. It is one of the most powerful cardiovascular risk stratification tools available — providing a direct, structural measurement of atherosclerosis rather than a statistical prediction.

A CAC score of 0 is highly reassuring and associated with very low near-term cardiovascular event risk, even in the presence of elevated LDL or ApoB. A score above 100 significantly changes risk stratification and often influences decisions about statin therapy, aspirin, and lifestyle interventions.

• CAC = 0: Very low near-term risk. Retest in 3–5 years.
• CAC 1–99: Mild plaque. Lifestyle optimization is the priority.
• CAC 100–399: Moderate risk. Discuss pharmacotherapy with your physician.
• CAC ≥400: High risk. Aggressive intervention warranted.
• Involves a small amount of radiation (~1 mSv). Requires physician order in most states.

Carotid Ultrasound (CIMT)

Carotid Intima-Media Thickness (CIMT) uses ultrasound to measure the thickness of the inner two layers of the carotid artery wall. It is non-invasive, involves no radiation, and can detect early atherosclerosis before it becomes symptomatic.

CIMT is particularly valuable for younger individuals where CAC may still be zero but early arterial changes are developing. It can also detect soft (non-calcified) plaque that CAC scanning misses. The combination of CAC and CIMT provides a more complete picture of arterial health than either test alone.

DEXA Scan — Body Composition

A DEXA (Dual-Energy X-ray Absorptiometry) scan is the gold standard for body composition assessment. It measures lean mass, fat mass, and bone density separately — and critically, it quantifies visceral fat, the metabolically active fat surrounding internal organs.

Visceral fat is a key driver of insulin resistance, inflammation, and cardiovascular risk. It is not captured by weight, BMI, or waist circumference alone. A DEXA scan provides precise, reproducible measurements that allow you to track changes in body composition over time.

FibroScan — Liver Health

FibroScan uses ultrasound-based technology to assess liver stiffness (a marker of fibrosis) and liver fat content (steatosis). It is non-invasive and can detect early non-alcoholic fatty liver disease (NAFLD/MASLD) before it progresses to fibrosis, cirrhosis, or liver failure.

NAFLD is now estimated to affect 25–30% of adults in developed countries — most of whom are unaware. It is closely linked to insulin resistance and metabolic syndrome. FibroScan provides early detection that standard liver enzyme tests (ALT, AST) often miss.

Continuous Glucose Monitor (CGM)

While not traditional imaging, a CGM provides real-time glucose data that reveals patterns invisible to fasting glucose and HbA1c — including post-meal spikes, overnight glucose trends, and glucose variability.

Even a 2–4 week CGM trial can provide significant insight into how specific foods, meals, sleep quality, and stress affect glucose regulation. This information is actionable in ways that quarterly HbA1c measurements are not.