At HormoneSynergy® Longevity Medicine, we offer Cleerly® AI-assisted coronary CT angiography analysis for appropriately selected patients who want a more detailed understanding of coronary artery disease than cholesterol testing or calcium scoring alone can provide.
The distinction matters. A calcium score can identify calcified plaque, but it cannot show noncalcified plaque. A CCTA provides detailed images of the coronary arteries using intravenous contrast. Cleerly® then analyzes suitable CCTA images to quantify and characterize coronary plaque more consistently.
This is not simply about finding whether an artery is severely blocked. It is about identifying the presence, amount, distribution, and characteristics of coronary atherosclerosis so prevention decisions can be based on the disease that is actually present.
CAC vs. CCTA vs. Cleerly®: What Is the Difference?
| Feature | CAC Scan | CCTA | Cleerly® Analysis |
|---|---|---|---|
| What it is | Noncontrast CT calcium screening | Contrast-enhanced coronary CT angiography | AI-assisted analysis of CCTA images, not another scan |
| Calcified plaque | Yes | Yes | Quantified and characterized |
| Noncalcified plaque | No | Yes | Quantified, including low-density plaque when identifiable |
| Artery narrowing | No direct measurement | Yes | Quantitative stenosis assessment |
| IV contrast | No | Yes, iodinated contrast | Uses the completed CCTA images |
| Typical role | Initial risk refinement in selected asymptomatic adults | Anatomic evaluation of coronary arteries when clinically appropriate | Detailed plaque quantification and prevention planning |
| Pricing | Often approximately $50–$250 when self-paid; varies by facility | Approximately $1,300–$1,400 through the HormoneSynergy® imaging partner, paid directly to the center | Included in the $1,995 HormoneSynergy® service; Cleerly charges HormoneSynergy® $950 for its analysis |
Why Soft Plaque Matters
“Soft plaque” commonly refers to noncalcified plaque, particularly lipid-rich or low-density plaque. It is an imperfect shorthand because noncalcified plaque is not one uniform substance and not every noncalcified plaque is destined to rupture.
Some heart attacks occur when a vulnerable coronary plaque ruptures or erodes, triggering a blood clot that suddenly obstructs blood flow. This can happen even when the plaque was not previously causing severe narrowing. For that reason, evaluating only whether an artery is “blocked” may miss clinically meaningful coronary disease.
A CAC score of zero means that no calcified coronary plaque was detected. It does not always mean that no coronary plaque exists. Younger patients and some people with significant risk factors may have noncalcified plaque before enough calcium has accumulated to produce a positive CAC score.
CCTA can visualize both calcified and noncalcified coronary plaque. Cleerly® adds quantitative analysis of total plaque volume, plaque composition, vessel narrowing, and plaque distribution. These findings can help a physician decide how aggressively to address ApoB, LDL-C, blood pressure, insulin resistance, smoking, inflammation, exercise, nutrition, and other modifiable risks.
Complete Cleerly® Pricing at HormoneSynergy®
HormoneSynergy® stand-alone Cleerly® service: $1,995
This includes the physician consultation and clinical review associated with ordering and interpreting the study, coordination of the Cleerly® analysis, and review of the completed findings. Of this amount, $950 is the analysis fee charged to HormoneSynergy® by Cleerly.
Imaging-center CCTA fee: typically $1,300–$1,400
This separate fee is paid directly to the imaging center for performing the contrast-enhanced CCTA.
Estimated combined total: $3,295–$3,395
HormoneSynergy® does not receive a commission or kickback from the imaging center and does not mark up its imaging charge. We are not contracted with insurance companies and do not bill insurers. HSA or FSA funds may be eligible, but reimbursement is not guaranteed.
Who May Benefit From CCTA With Cleerly® Analysis?
Testing may be considered for people with elevated ApoB, LDL-C, lipoprotein(a), triglycerides, hypertension, insulin resistance, diabetes, metabolic syndrome, a strong family history of premature cardiovascular disease, or uncertainty after conventional risk assessment.
It may also be useful when a calcium score does not adequately answer the clinical question, when symptoms require anatomic coronary evaluation, or when a physician needs more detailed information about known or suspected coronary plaque.
Testing is not automatically appropriate for everyone. Age, symptoms, previous coronary procedures, heart rhythm, kidney function, contrast allergy, pregnancy status, radiation exposure, prior imaging, and the likelihood that results will change treatment should all be considered.
What Happens During a CCTA?
The CCTA is performed at a partner imaging center. An intravenous line is used to administer iodinated contrast. Depending on heart rate and medical appropriateness, medication may be used to slow the heart, and nitroglycerin may be administered to improve visualization of the coronary arteries.
The resulting images are interpreted clinically and submitted for Cleerly® analysis when image quality and other requirements are met. Cleerly® produces a report describing coronary plaque burden, plaque type, vessel narrowing, and related measurements. Dr. Kathryn Retzler then reviews the findings within the context of the patient’s laboratory data, history, symptoms, and overall cardiovascular risk.
CAC May Still Be the Right First Test
CCTA and Cleerly® should not make CAC obsolete. A calcium score is fast, relatively affordable, does not require contrast, and can meaningfully refine preventive decisions in appropriately selected asymptomatic adults.
The better test depends on the question. If the primary question is whether calcified coronary atherosclerosis is present, CAC may be sufficient. If the question requires visualization of the coronary arteries, noncalcified plaque, total plaque burden, or stenosis, CCTA may provide substantially more information.
Testing Is Not Treatment
Advanced imaging is valuable only when it improves clinical decisions. Results may influence nutrition, aerobic and resistance exercise, blood-pressure management, glucose control, smoking cessation, sleep, medication decisions, and evidence-informed supplementation.
Finding plaque does not automatically dictate one treatment, and a normal result does not eliminate the need to address major risk factors. Imaging should complement—not replace—ApoB, LDL-C, lipoprotein(a), blood pressure, glucose regulation, family history, symptoms, and physician judgment.
Dr. Arthur Agatston, developer of the coronary calcium score, discusses incorporating Cleerly® CCTA analysis into clinical practice.
Related Cardiovascular Resources
Request Cleerly® Testing Information
A physician consultation can help determine whether CAC, conventional CCTA, or CCTA with Cleerly® analysis best fits your symptoms, history, and cardiovascular risk profile.
Frequently Asked Questions
Is Cleerly® the same as a CCTA?
No. CCTA is the contrast-enhanced imaging examination. Cleerly® is an AI-assisted analysis performed on suitable CCTA images.
Can a CAC score detect soft plaque?
No. CAC scoring detects calcified plaque. It does not directly visualize noncalcified or low-density plaque.
Can someone have coronary plaque with a CAC score of zero?
Yes. A zero score means no calcified plaque was detected, but noncalcified coronary plaque may still be present, particularly in younger people and selected higher-risk patients.
Does soft plaque always cause a heart attack?
No. Not every noncalcified plaque will rupture. Certain plaque characteristics are associated with greater risk, but imaging findings must be interpreted alongside the complete clinical picture.
How much does Cleerly® testing cost through HormoneSynergy®?
The HormoneSynergy® stand-alone service is $1,995, including the Cleerly® analysis, for which Cleerly charges HormoneSynergy® $950. The imaging center typically charges another $1,300–$1,400 directly. The estimated combined total is $3,295–$3,395.
Is CCTA appropriate for sudden or severe chest pain?
Possible heart-attack symptoms require immediate emergency evaluation. This outpatient testing service is not a substitute for calling 911 or obtaining urgent emergency care.
Does HormoneSynergy® bill insurance?
No. HormoneSynergy® is not contracted with insurance providers and does not bill insurers. HSA or FSA funds may be eligible, but reimbursement is not guaranteed.
Editorial Transparency: This page is educational and does not imply that CAC, CCTA, or Cleerly® testing is appropriate for every patient. HormoneSynergy® receives no commission or kickback from its imaging partner. Medical claims were reviewed against information from the American Heart Association, multisociety chest-pain guidance, the Society of Cardiovascular Computed Tomography, and Cleerly® patient education. Cleerly® is a registered trademark of Cleerly, Inc.
Sources: American Heart Association: Coronary Artery Calcium Test; 2021 Multisociety Chest Pain Guideline; Society of Cardiovascular Computed Tomography Guidelines; Cleerly® Patient Education.