Among 7,135 insured, symptom-free Florida adults aged 45 to 70 with at least one cardiovascular risk factor, coronary CT angiography and calcium scoring flagged 56.8% as abnormal or very abnormal; 11.4% fell into the highest-risk category. Abnormal findings climbed from 39.3% at ages 45 to 55 to 78.5% at 71 or older, and appeared far more often in men than women (68.9% vs 39.8%; OR 3.36). Rates were lower in Black than White participants (38.9% vs 58.6%), and abnormal results ranged from 39.5% to 60.3% across four health systems.
The headline number mostly confirms what imaging studies such as MESA and CAC Consortium already showed: subclinical plaque is common by middle age, especially in men. The more interesting signal is the 20-point spread between health systems, which hints at differences in scan interpretation or referral patterns rather than biology. Two caveats matter. First, this is a descriptive analysis of aggregate program reports with no follow-up, so it cannot show whether detecting plaque prevented heart attacks or deaths; that question still rests on trials like SCOT-HEART and DANCAVAS, whose benefits remain debated. Second, "abnormal" was defined by the program team, and the screened group underrepresented Black, Hispanic, and female residents, limiting generalizability. Because this is a preprint that has not been peer reviewed, the figures could change. For readers, the practical takeaway is modest: a positive scan is a prompt to discuss blood pressure, ApoB, and statin decisions with a doctor, not proof that screening saves lives. Incremental and confirmatory.