Coronary Calcium Scoring vs. GlycoCheck and who should get what
If you’re trying to understand your true cardiac risk, here’s the uncomfortable truth most people never hear:
You can’t manage what you don’t measure and you can’t reduce risk if you’re only looking at the end of the story.
Coronary calcium scoring and GlycoCheck are often framed as competing tests. They’re not. They answer entirely different questions, at different moments in the disease timeline.
One tells you what damage already exists.
The other tells you how healthy the terrain is right now.
Let’s break that down.
Coronary Calcium Scoring: The Scoreboard
What’s already on the board
A coronary artery calcium score is a low-dose CT scan that measures calcified plaque in the coronary arteries.
Think of it as the final score of a game that’s already been played.
- CAC = 0
No detectable calcified plaque. Not zero risk, but reassuring. - CAC 1–99
Early plaque. Disease has started. - CAC ≥100
Established coronary artery disease. Risk is real, not theoretical.
What CAC does well
- Strong predictor of future cardiac events
- Excellent for refining statin and prevention decisions
- Hard to argue with when it’s elevated
What CAC does not tell you
- Why plaque formed
- Whether your vascular system is improving or deteriorating
- Anything about microvascular or endothelial health
CAC is powerful, but it’s backward-looking. It tells us where you’ve been.
GlycoCheck: The Playing Field
How the game is being played right now
GlycoCheck evaluates the microcirculation and endothelial glycocalyx, the delicate, protective lining of your blood vessels that regulates:
- Blood flow
- Nitric oxide signaling
- Inflammation
- Vascular permeability
This layer is where cardiovascular disease begins, long before plaque calcifies.
When the glycocalyx is damaged, red blood cells penetrate deeper into the vessel wall, flow becomes chaotic, inflammation rises, and vascular dysfunction accelerates.
What GlycoCheck does well
- Detects early endothelial stress
- Reflects metabolic and inflammatory burden
- Tracks improvement with lifestyle, sleep, glucose control, blood pressure optimization, and targeted therapies
What GlycoCheck does not do
- Diagnose coronary artery disease
- Replace plaque imaging
- Predict events as a standalone test
GlycoCheck is forward-looking. It tells us where you’re heading.
Who Should Get What
This is where most systems fail and we don’t
At James Clinic, we don’t believe in blanket testing. We believe in right test, right patient, right time.
Coronary Calcium Scoring is best for:
- Adults 40+ with borderline or intermediate cardiovascular risk
- Patients deciding whether statins actually make sense
- Strong family history of heart disease
- Patients who want clarity instead of guessing
- Anyone tired of being told “your labs look fine” without evidence
If your CAC is elevated, we move decisively. If it’s zero, we don’t over-medicalize.
GlycoCheck is best for:
- Patients with metabolic dysfunction or insulin resistance
- Athletes and high performers optimizing vascular efficiency
- Early prevention in younger patients not yet eligible for CAC
- Tracking response to interventions over time
- Patients with symptoms despite “normal” traditional testing
This is especially valuable when CAC is zero but risk factors are brewing quietly under the surface.
Who benefits from both?
- Executives under chronic stress
- Patients with conflicting lab results
- Those with normal cholesterol but abnormal physiology
- Anyone serious about preventing disease instead of reacting to it
CAC tells us if disease exists.
GlycoCheck helps us change the trajectory.
The Rebel Take
Here’s where we diverge from conventional care:
- CAC alone tells you if you’re late to the party
- GlycoCheck alone tells you the music is getting louder
- Together, they let us intervene before the room catches fire
Waiting for plaque to calcify before taking heart health seriously is like waiting for a house to burn down before installing smoke detectors.
We prefer prevention with data.
Side-by-side: what each test is “best at”
| Test | What it measures | Best use | Where it can mislead |
| CAC score | Calcified coronary plaque burden | Clarifying ASCVD risk, especially borderline-to-intermediate risk decisions | Early disease before calcification; doesn’t directly measure endothelial function |
| GlycoCheck (glycocalyx/microcirculation) | Microvascular flow + glycocalyx integrity proxies like PBR | “Terrain” monitoring: endothelial stress, microvascular health trends; another layer for metabolic/inflammatory risk | Predictive power for events is less established; results can be confounded and shouldn’t be used alone |
So which one “determines cardiac risk” better?
If we’re talking hard, guideline-backed risk prediction for coronary events, CAC generally wins because it directly measures coronary plaque burden and is embedded in prevention frameworks
If we’re talking earlier physiology and modifiable vascular function, GlycoCheck can be valuable as part of a broader strategy, especially when paired with metabolic markers, inflammation, blood pressure, and advanced lipids. The science supports physiologic relevance, but the event-prediction story is still evolving.
Bottom Line
If you want a single number to reassure you, get a CAC.
If you want to understand your vascular health and influence it, use GlycoCheck.
If you want to practice grown-up cardiovascular medicine, use both strategically.
At James Clinic, we don’t just read the scoreboard.
We change how the game is played.