Artificial intelligence tools can detect additional details about the amount and type of plaque in the heart's arteries. However, it remains to be seen whether this information can help prevent more heart attacks.

Atherosclerosis

Atherosclerosis, a condition where plaque builds up inside artery walls, causes arteries to lose their elasticity (or become stiff). Although some of this plaque is calcified and hard, other plaque is not; soft (non-calcified) plaque is actually more dangerous due to its higher likelihood of rupturing and forming a clot that leads to a heart attack.

A specialized computed tomography scan, known as coronary computed tomography angiography (CCTA), can detect both hard and soft plaque, as well as blockages in the arteries that supply the heart.

Artificial intelligence to analyze artery images

Many medical device companies are marketing AI algorithms that analyze these images more deeply to quantify each type of plaque in the heart's arteries. Earlier this year, some private insurance companies and Medicare began covering the costs of AI-based reports, which range from $850 to $1,000, in addition to the cost of the CCTA scan itself.

Do the additional insights from these AI-enhanced results make a substantive difference? In other words, can knowing the precise amounts of soft and hard plaque change your doctor's treatment recommendations? And will following those recommendations reduce your likelihood of having a heart attack?

Dr. Michael Lu, director of artificial intelligence at the Cardiovascular Imaging Research Center at Massachusetts General Hospital, Harvard University, says: 'At this point, we don't really know that. But several studies are underway to explore this.'

New trials to test the promising potential of AI analysis of atherosclerosis

In July 2026, 25 research sites across the United States—including Massachusetts General Hospital, Harvard University—began enrolling participants in a clinical trial sponsored by the National Institutes of Health (NIH) aimed at finding better ways to prevent heart attacks.

Dr. Michael Lu, associate professor at Harvard Medical School and co-principal investigator of the trial, says: 'The goal is to identify people in young to middle-aged groups with atherosclerosis, and test different strategies—including AI-enhanced plaque analysis—to reduce the amount of plaque in the coronary arteries.'

For more information about this clinical study, which is scheduled to conclude by 2032, please visit: https://preemptstudy.org.

Traditional methods for detecting atherosclerosis

- Stress tests: In the past, doctors relied on stress tests to detect blockages in the heart's arteries. These tests monitor the heart's electrical activity, heart muscle function, and blood flow patterns while the heart is stressed by exercise or stimulant medications. However, abnormal results typically appear only when a person has significant narrowing in one or more arteries (blockage exceeding 70 percent).

- Angiography: After an abnormal stress test result, the next step was often angiography—a procedure involving inserting a catheter into an artery near the wrist or groin, guiding it to the heart, and injecting a dye that appears clearly on X-ray images. The resulting two-dimensional image reveals how efficiently blood flows through the heart.

- CT scan of the heart's arteries: This scan is faster and less invasive than traditional angiography. It involves injecting dye into the arm, followed by a series of high-speed X-ray images that create three-dimensional images of the heart's blood vessels. This procedure is recommended as an initial tool for evaluating people with chest pain or other symptoms that may be heart-related.

- Calcium score measurement: This is a computed tomography scan to measure coronary artery calcium (CAC), which also detects atherosclerosis, but only detects calcified hard plaque, not the more dangerous soft plaque. This test (CAC) is recommended to assess future heart attack risk for asymptomatic individuals who fall into the borderline or intermediate risk category for cardiovascular disease.

Controlling blood pressure

One in three American adults has high blood pressure, which is concerning. Although this condition is medically known as hypertension, many people are unaware they have it because there are no clear symptoms or warning signs. But when high blood pressure is combined with abnormal cholesterol and blood sugar levels, damage to the arteries, kidneys, and heart accelerates dramatically.

Fortunately, high blood pressure is easy to detect and treat. Through the special health report 'Controlling Your Blood Pressure,' you can learn how to keep your blood pressure within a healthy range by making lifestyle changes such as losing weight, increasing physical activity, and following a healthy diet.

AI and atherosclerosis: advantages and limitations

Dr. Michael Lu explains that coronary computed tomography angiography (CCTA) has been used for years in clinical trials to monitor the response of soft plaque to drug therapy. He says: 'We start by giving patients a drug or placebo, then repeat the CT scan after a year or two.' Currently, a physician spends an hour or more reviewing each scan manually to measure the volume of hard and soft plaque. Theoretically, AI can perform this task much faster.

However, Dr. Michael Lu points out that no AI application is perfectly accurate (100 percent), so results will still need to be reviewed by a physician.

Current observational data suggest that AI plaque analysis provides useful information that could improve care and enhance heart health.

Dr. Michael Lu adds: 'But many experts are waiting to see whether AI-guided plaque analysis will actually help prevent more heart attacks, and whether the added cost is justified.'

* Harvard Heart Letter, Tribune Media Services