CORONARY CALCIUM SCORE

Dr Reza Moazzeni

Nov 2, 2020

Background

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FACT: Heart attack is our "number one" killer, even during COVID pandemic. For many years, we have been trying to "invent" tools to predict the risk of Heart Attack and everyone (literally everyone), is intrested to know thier risk. 

Background

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Many "calculators" been designed to serve this purpose, which have been successful tremendously, but recent evidence have shown that they can miss, many preventable cases. 

Coronary Artery Calcium Score (CAC score)

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For the past 15 years, significant, large-scale studies have shown that "calcification" of the cardiac arteries, is a very strong marker of future heart attack risk.  This "calcification", signifies the presence of underlying "plaque" which is the hallmark of ATHEROSCLEROSIS.

How is CAC score done?

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- It's a 5 min CT scan, done in a radiology practice.  - Has "no" risk and  radiation is equivalent to roughly about 2.5 mamograms.  - No "needle" or injection involved and no prepration required. 

How much does it cost?

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About $100, (about 20 coffees) but it's a test that "most likely" you don't have to repeat, depending on the results. Considering the information you get, that cost is "negligible".  20 coffees to get priceless info about your risk of heart attack!!

For the price of 20 coffees you get to know whether you arteries look like this, with no calcium

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Or they look like this, with significant calcification

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Ok, I have lots of calcium in my arteries, what next?

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Simply, if you have "lots" of calcium in your arteries, your risk of future Heart Attack is high. knowing this, will motivate you to modify your lifestyle for the better and your doctor can start "life saving" therapies. This will mitigate the risk, significantly.  Bottomline, you will be well-prepared to deal with risks. 

How much calcium is "too much"?

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Anything above 300, is very high, but it's not just about the score or "absolute number". Let's say your score is 20. If you are young (let's say 35), this is considered "very high" for your age group. But if you are 70, then a score of 20 is within the acceptable rang for "that age group". So "age" is a very important factor here.

I'm 35, should I check my CAC score?

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CAC score, is usually recommended when you are above 40-45.  At 35, your Ca score will most likely be zero, but that is not a cause for celebration as your body has not "aged enough" yet, to be calcified. You could have lots of "cholestrol or plaque" in your arteries, but no calcium, yet. Calcium will come with "time". On the other hand, if at 35 your CAC score is high, that's "very" concerning. So at younger ages, we are more intrested in high numbers, rather than zero.

I'm 60, have very high cholestrol and two brothrs and father with heart attack. Should I check CAC score ?

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Well, theoretically you can, but even if your calcium score was zero, you are ALREADY AT HIGH RISK for heart attack and need  intensive treatment.  Remember, CAC score is a tool to "predict risk" and we already know your risk is high, so no point in doing CAC score.

I'm 50 and my CAC score was zero. Dos that mean my risk of heart attack is zero?

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Absolutely NOT. CAC score is just another piece of puzzle to be considered WITH other risk factors and if it's zero, in the right setting and age, it can be quite reassuring.   If you dont't have symptoms and have low risk profile, a score of zero means your risk for the next 5 years, is very low.

NO ONE'S RISK OF HEART ATTACK IS EVER ZERO, DESPITE ANYTHING YOU DO OR ANY TEST YOU PERFORM.

My CAC score was 200. Do I need to repeat this test every year?

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NO. Your risk is elevated and you need treatment and lifestyle modifications, end of the story.  CAC score does not "go down" with treatment and DOES NOT need to be repeated .

My CAC score was 0. Do I need to repeat this?

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Very rarely. Depends on the other risk factors and whether you are on treatment or not. If you are 40 and have some high cholestrol and decide against medical therapy, maybe you could repeat the test at 45 or 50 to see there has been any change.   Just remember that a calcium score of zero, is NOT your free ticket to smoke, eat unhealthy and avoid exercise and treatment. Heart Attack "can" happen even with a score of zero, if you don't modify other risks. 

What's the message?

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If you are between 40-70 and curious about the risk of Heart Attack AND you don't have chest pain AND you don't have other significant risk factors for heart attack (low-risk profile), I  suggest adding the CAC score to the mix to come up with a more accurate assessment.  This test does NOT need to be repated in most people, if done properly.  

Remember that CAC score is only "one piece" of the puzzle and should not be assessed, alone.

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