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What is Coronary Calcium Score? | Video
Video: This video illustrates the importance of Coronary Calcium Score, when to consider and how to interpret the results.
Coronary Artery Calcium, or CAC score, is a valuable test to estimate the future risk of a heart attack. I will discuss the pros and cons of this test and how it can be helpful or harmful if ordered and interpreted inappropriately.
For decades, investigators have been trying to discover the “risk factors” that increase the likelihood of heart attack. Many risk factors have been identified through years of intensive and elegant research [1], including Smoking, Obesity, a sedentary lifestyle, high blood pressure (hypertension), positive family history of heart attack, menopause, inflammatory diseases like rheumatoid arthritis, and last but not least, Diabetes. Many studies have proven that we can significantly reduce the risk of heart attack by modifying these factors.
Despite these massive efforts and discoveries, still, many individuals suffer from a heart attack prematurely without having any or only a few of these risk factors. This fact suggests that our current risk calculators, developed based on “traditional risk factors,” are far from perfect. They can potentially miss many “preventable” cases of heart attack.
During the past 15 years, coronary calcium score has emerged as a reliable “predictive” test to further refine someone’s risk of future heart attack by identifying atherosclerosis.
Plaques are the main precursors of myocardial infarction. Atherosclerosis is an inflammatory process in the arterial wall that starts at a young age and is the primary driver of the “plaque” formation in the arterial wall. As we age, the process of calcification begins within the plaques. We can then identify the calcium in x-ray images, confirming the presence of an underlying plaque.
High cholesterol levels (Hypercholesterolemia), familial (FH) or non-familial, is a significant risk for early-onset coronary artery disease and atherosclerosis.
If you have high LDL-cholesterol levels, particularly at a young age, utilizing an “online FH calculator” can provide valuable insights into whether your hypercholesterolemia is genetically inherited. To learn more about Familial Hypercholesterolemia, check out the related article and video.
Figure 1: This CT scan, which belongs to a 60-year-old asymptomatic man, shows significant calcification of the LAD and RCA arteries. It implies that under this bulk of calcium, the process of “atherosclerosis” is progressing fast, which, if not controlled, can result in acute coronary syndromes (heart attack).Â
He was initially labelled as “low-risk” based on traditional risk factor calculations. But this mere new fact (high coronary calcium score) will change his previous “low risk” status to “high-risk.”
Listen to the article
When should you consider checking your calcium score?
There has been significant debate as to what clinical situation a coronary calcium score should be considered. CAC Score is a preventive test and should not be used in symptomatic patients (if someone has chest pain or shortness of breath). It is another piece of the puzzle to shed more light on someone’s “future risk of a Heart Attack”.Â
Before considering a calcium score, it is crucial to calculate the patient’s baseline risk of a heart attack. Many online calculators like this online calculator from the American College of Cardiology can do this. It needs a few baseline information like the presence of Diabetes, Hypertension or high cholesterol levels. Smoking status, age and medications are other components. Based on this information, a 10-year risk estimate is generated. The patient will be categorised as low-risk, intermediate-risk, or high-risk for future heart attacks.Â
To illustrate how the CAC score check can be helpful, here I present a typical case.
CASE: A 55-year-old man presents to you after his close friend suffered a massive myocardial infarction. They have been colleagues and used to exercise regularly with weekly swimming, cycling, and running regularly and intensely. He does not smoke, eats healthy, and has no significant family history of ischaemic heart disease. His cholesterol is on the low side, and he has mild hypertension, which is well-controlled with a low-dose antihypertensive. He is not complaining of any symptoms indicative of angina. He insists that his friend had the same profile and was at low risk for myocardial infarction. In this scenario, a test that can add significant weight and information to stratify his risk for future IHD is a coronary calcium score. He performs a CAC score, which comes back as 300. A calcium score at this level will immediately move him from the low-risk category to the moderate-high-risk category. He will undoubtedly benefit from intensive reduction of his LDL to 1.4-1.6 mmol/L and the addition of Aspirin.
This case illustrates that coronary calcium score should only be considered in individuals with “low to intermediate” baseline risk. A high coronary calcium score can modify someone’s low-risk status to high-risk, but a low or even zero calcium score does not change the status of a high-risk patient to low-risk. We should remember that A “high-risk” individual will remain “high risk” regardless of their calcium score. They should be on intensive therapy with Statins, Aspirin and encouraged to change their lifestyle rather than checking their calcium score.
What is the ideal age to check coronary calcium score?
Coronary Calcium test should be considered in individuals between 45-70 years of age. This does not mean those below 45 or above 70 cannot have the test, but the interpretation of the results should be guarded. Under 40, there has not been enough time for the lipid-rich plaques to calcify, and we can miss them on imaging as we can only see them if they are already calcified. For example, a young patient with familial hypercholesterolemia could have many “coronary plaques” at 30. Still, their CAC score could be zero, as no calcium has yet formed in the plaques. This can be misleading and result in “false reassurance”. However, a high calcium score in a young patient is highly concerning and should be taken seriously. It indicates that they already have formed coronary plaques with an increased risk of future IHD.
Above 70, nearly everyone has calcification of the coronary arteries. An elevated calcium score in the elderly, unless “significantly” elevated, does not necessarily indicate “high risk”. However, a low or0 calcium score in this age group can be extremely reassuring.
Therefore rather than concentrating on the “absolute” number of the calcium score, you should see where you stand compared to the people your age. By incorporating the “age factor” in our calculations, we reach a “percentile”, which is much more accurate in risk assessment compared to the “absolute” number. The MESA CAC score calculator is an excellent tool in this regard.
How should we interpret a calcium score of 0?
To show the importance of this point, I have briefly discussed two cases of “severe coronary artery disease despite a calcium score of zero” in a separate post. Hopefully, these cases will explain why we can’t call a calcium score of zero, “normal”, without considering the patient’s age and other risk factors.Â
How should a high calcium score be interpreted?
We know that Coronary calcium score must be interpreted according to age. A calcium score of 20 in a 70-year-old is considered low and excellent but significantly elevated for a 40-year-old. Many online charts show the risk according to the calcium score. However, interpreting the calcium score results is not as simple as looking at a chart and coming up with an answer. Many factors are involved in this process, and each result should be interpreted individually according to the patients, age, risk factors and likely complaints.
A calcium score above 300-400 is significantly elevated at any age. These patients require tighter control of their risk factors, Aspirin in certain cases and intensive cholesterol-lowering medical therapy, including statins, non-statin oral treatments like Ezetimibe and Bempedoic Acid and PCSK9 inhibitors and Inclisiran. Knowing their “high” risk motivates patients to be physically more active and follow a healthy diet. However, a high calcium score must never initiate the process of looking for “blockages” in coronary arteries or end up in angioplasty if the patient is “truly” asymptomatic.
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Should the calcium score test be repeated in future?
Generally, if the calcium score is high, there is no need to repeat the test. A high score means the patient’s risk of ischemic heart disease is elevated, and they need intensive treatment of their risk factors and lifestyle modifications, and there is no need to repeat the test. A high-risk patient will remain high-risk, regardless of the future CAC scores.Â
Select patients with a calcium score of 0, especially younger individuals, could consider repeating the test in 5 years, particularly if they have a few risk factors like high cholesterol or blood pressure and decide against medical therapy.
Is a calcium score test required for someone already on a statin?
The answer generally is no, but it depends on the case. A CAC test is not required if the patient is taking their medicine regularly and their LDL is around 2 mmol/L (77 mg/dl). However, if they are taking statin sparingly, and LDL is way above 2 mmol/L, we can consider a CAC test to guide the therapy. A more lenient approach towards medical therapy can be taken if the score is 0 or very low and vice versa. In the following video, I present a real case and show how Coronary Calcium Score can change someone’s cardiovascular risk profile and how it can be helpful or harmful.
Frequently asked questions:
How is coronary artery calcium measured, and how much does it cost?
- To learn more about the cost of a CAC score and how it is done, check this Coronary Calcium Score WebStory.
What is a normal calcium score?
- At any age, a calcium score of 0 is considered optimal and normal. This score indicates that no “calcified” plaque is present in the coronary arteries, a positive sign for heart health. However, it is crucial to remember that a calcium score of 0 may not tell the whole story. If “non-calcified” plaques are present, the score will still be 0, providing a false sense of reassurance. This limitation is a critical aspect to consider when evaluating the results of a coronary artery calcium scoring test.
Can I reduce or reverse my calcium score?
- A calcium score indicates one’s future risk of experiencing a heart attack. If the score is elevated, it is crucial to focus on strategies to reduce the overall risk of cardiovascular disease rather than fixating on the “number” itself. Effective methods for risk reduction include quitting smoking, engaging in regular exercise, maintaining a healthy diet, and, depending on the score and cholesterol levels, potentially using statin therapy.
- It is worth noting that your calcium score might increase after initiating statin therapy and incorporating exercise into your routine. This increase is not necessarily a negative development, as it could indicate that plaques are hardening and becoming more stable, subsequently reducing the risk of a heart attack. For further information, watch this video, Coronary Calcium Score: How to Interpret.
Can an echocardiogram detect coronary calcium?
- An echocardiogram is a diagnostic test that utilizes ultrasound waves to create images of the heart, providing valuable information about its chambers, valves, and overall function. However, an echocardiogram does not directly visualize the coronary arteries or reveal the presence of calcification in these vessels.
Can stress tests detect the coronary calcium score?
- No. A stress test or Stress echocardiogram is a diagnostic examination that evaluates exercise tolerance and can help detect coronary artery narrowing or blockages. This test utilizes ultrasound waves, similar to standard echocardiograms, but it is not designed to identify coronary calcifications. A stress test is a distinct type of investigation and is not comparable to a coronary calcium score test. These two serve different purposes and provide unique insights into an individual’s heart health.
Does CT Coronary Angiogram show calcium score?
- Many radiology facilities automatically include calcium scores in CT Coronary Angiogram (CTCA) reports, but some may only provide them if specifically requested. To ensure your report contains a calcium score, ask your doctor to request it alongside your CTCA. For further insight into the differences, limitations, and indications of CTCA versus CT Calcium Score scans, review the article “CT Coronary Angiogram vs. CT Calcium Score: Differences, Limitations, and Indications.”
If I can have a CT Coronary Angiogram that includes the calcium score, why should I only do a calcium score?
- CTCA and CT calcium scores are separate tests we use in different scenarios. We generally perform CT Coronary Angiogram (CTCA) in individuals experiencing symptoms suggestive of coronary artery disease (CAD) or having inconclusive stress test results. The CTCA allows for detailed visualization of the coronary arteries to identify any potential blockages or narrowing that could be causing these symptoms.
- On the other hand, we only use the CT Calcium Score for risk assessment in asymptomatic individuals with low-intermediate risk factors for CAD. This test helps determine the presence and extent of calcified plaque in the coronary arteries—an indication of atherosclerosis that raises the likelihood of future cardiac events. Please refer to the article CTCA vs CT Calcium Score to learn more.
CAC score is only "one" piece of the puzzle
The coronary artery calcium score is only one piece of overall risk factor puzzle. Like any other test in medicine, it has pros and cons, can be helpful or harmful and should be used judiciously. It clarifies someone’s risk for future ischaemic heart disease and should never be interpreted solely without having the whole picture in mind. It should never be used to investigate chest pain and should not be ordered in high risk patients.
References and further reading
- DeGoma EM. The evolution and refinement of traditional risk factors for cardiovascular disease. Cardiol Rev. 2012;20(3):118-129.Â
- Maureen M et al. Noninvasive Evaluation With Multislice Computed Tomography in Suspected Acute Coronary Syndrome: Plaque Morphology on Multislice Computed Tomography Versus Coronary Calcium Score. J Am Coll Cardiol. 2008 Jul, 52 (3) 216–222
- Greenland P. Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. JAMA. 2004;291(2):210-215.
- Budoff MJ, et al. Long-term prognosis associated with coronary calcification: observations from a registry of 25,253 patients. J Am Coll Cardiol. 2007;49(18):1860-1870.
- Detrano R, et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med. 2008;358(13):1336-1345.
- Yeboah J, et al. Comparison of novel risk markers for improvement in cardiovascular risk assessment in intermediate-risk individuals. JAMA. 2012;308(8):788-795.
- Blaha MJ, et al. Associations between C-reactive protein, coronary artery calcium, and cardiovascular events: implications for the JUPITER population from MESA, a population-based cohort study. Lancet. 2011;378(9792):684-692.
- Nasir K, et al. Implications of coronary artery calcium testing among statin candidates according to American College of Cardiology/American Heart Association cholesterol management guidelines: MESA (Multi-Ethnic Study of Atherosclerosis). J Am Coll Cardiol. 2015;66(15):1657-1668.
I am white male, 43 years old, non smoker and exercise regularly. I had a CT scan due to family history, and have a score of 51. The doctor indicated that no lifestyle changes or medication is needed, as I am typically considered low risk- but judging by your article it’s actually quite high for someone in my age group. Keen to understand if I should seek a second opinion
Hi Craig,
Thank you for sharing your experience. Based on the information provided, a Calcium Score of 51 places you in the 92nd percentile for your age group. This means that 92% of individuals in your age bracket have a lower CAC score than you, and notably, 80% of them have a score of zero.
However, it’s essential to understand that the coronary artery calcium (CAC) score represents just one aspect of cardiovascular risk assessment. Many other factors come into play, such as family history (which you’ve mentioned), LDL-Cholesterol levels, Lp(a) levels, lifestyle habits like smoking, and more.
I trust that your doctor has made recommendations based on a thorough evaluation of your unique circumstances. Nonetheless, if you’re feeling concerned or uncertain about the provided advice, seeking a second opinion can offer additional peace of mind.
I’m a white, male, age 67 who’s father did have a heart attack. I smoked for 20 years but haven’t smoked in the last 20 years. I did have some chest pains and the doctor put me on high blood pressure medicine and ordered a stress test. All my blood work is good, but my calcium score was 30. The doctor wants to “go in” and check to see if i need a stent and do it while he’s “in there” if needed. Is this a normal, recommended procedure in this case?
Thank you for sharing your situation. It’s important to note that while the coronary calcium score can provide valuable insights into plaque burden, its value in the context of symptomatic patients like you, experiencing chest pain, is minimal. The calcium score is utilized for risk assessment in ASYMPTOMATIC individuals. Since you’ve mentioned chest pain, more direct imaging or functional studies, such as stress tests, are more relevant. Your doctor’s approach to considering angiography (and potential stenting if required) is guided by clinical judgment, and I recommend following his advice. Remember, managing risk factors tightly is critical, and adhering to medical advice is paramount.
Bless you for publishing this column. I’ve learned more from this one website than years and years of trying to understand. I am 72 and have just had my third CT scan, probably it was unnecessary as I was already above normal 12 years ago with scores around 350, 6 years ago with scores around 450, and now scores in the 600s. The most important thing I have learned from reading this column is that there is not a straight line correlation between these scores and the actual amount of plaque. Also that someone totally asymptomatic and slim and athletic like me , is already doing most of what has to be done to stay healthy. You even clarified why statins would be helpful in stabilizing the plaque. So grateful. I was in a panic but now I am feeling more like a normal human being and I’m ready to do what needs to be done, and nothing more. Wish I had read this a few years ago. Thank you thank you thank you
Hi Betsy,
Thank you so much for taking the time to share your experience and kind words. I’m humbled to know that the content here has provided clarity and peace of mind regarding your cardiovascular health. Your observations are on point. While calcium scores are valuable risk stratification tools, they are just one piece of the larger cardiac health puzzle. Maintaining an active, healthy lifestyle is crucial in promoting heart health and health in general.
Please remember that while being informed is essential, it’s equally important to maintain regular communication with your healthcare provider for guidance tailored to your situation.
Regards
At the outset, this article and video on this topic is second to none. Full stop.
I’m a 63-year-old male, 6′ 3″, 208 lbs. Exercise moderately. Diet is not rich in saturated fats, and I rarely eat red meat. My diet could be healthier. ECGs indicate presence of RBBB.
In November 2017, I requested CAC and scored 822. At the time my LDL was 4.02 mmol/L and total CHOL was 5.82 mmol/L Standard of care was 5mg of Rosuvastatin. LDL dropped to 2.31 in 2 months. In January 2020, I had another CAC with a score of 1225 and dosage was increased to 10 mg. Remarkably, my LDL has increased over time and remained in the 2.80 range. Lipid profile was in line with references in Canada. Glucose, HbA1c and insulin all within reference ranges.
In late June of this year, I was referred to a cardiologist when I had chest pain. He increased the dosage to 20 mg. Last week I underwent a stress echo, ABI, and vascular testing on the carotid, legs and abdomen. Results of the tests are pending. I have yet to have a lipid panel since the dosage increased, however, my goal is to reduce LDL to under 2.0 mmol/L by way of an improved diet, a more rigorous exercise program and a more aggressive statin therapy.
My question Dr. Moazzeni, is should I consider non-invasive CT angiography? Am I on the right path in general?
Hi Paul,
Thank you for the kind words about the article.
When we talk about a calcium score over 1000, it does indicate a higher risk of significant coronary artery disease. Regarding CT angiography, the decision largely depends on the results of your stress echocardiogram. If the stress echo results are unremarkable, I typically advocate for aggressive lifestyle changes combined with optimized cholesterol management to reduce LDL levels to around 1.4 mmol/L (55 mg/dl) as you have established Coronary Artery Disease. I usually combine statins with Ezetimibe for added benefit. Aspirin could also be a consideration, depending on other factors.
An interesting observation you’ve made is the rise in LDL despite being on a statin. Assessing Lp(a) as part of your lipid panel might be beneficial. As you may know, while Lp(a) largely resembles LDL, current cholesterol-lowering therapies, such as statins, don’t significantly reduce Lp(a). When checking LDL cholesterol levels, the cholesterol in Lp(a) is incorporated, which might explain the elevated LDL readings if your Lp(a) is notably high.
You are certainly on the right path to staying healthy. Please continue to engage with your cardiologist for tailored advice and management.
I’m a 56yr old male, 180cms tall and weigh 73kg (160lbs).
Very active, exercising most days either being cardio (bike riding), weight sessions and walking.
I had some blood work and as expected my overall cholesterol is high 8.1H mmol/L.
Triglycer = 0.6 mmol/L
HDLC = 2.50 mmol/L
LDLC = 5.3H mmol/L
LDLC/HDLC = 2.1
Chol/HDLC = 3.2
As expected, the doctor wanted to put me on a statin which I refused but suggested that doing a CT Coronary Artery Calcium would be a good test to determine if the high cholesterol is really an issue as I follow a carnivore diet. Not strict but is 95% of my diet.
Well, the CAC score came back of 797 which really shocked me. I wasn’t expecting that.
With such a high score the risk is high of a heart attack.
Blood pressure is good, resting heart rate is in the mid 50’s, no diabetes.
So the recommendation is to change the diet and reduce saturated fats (fatty meat, diary) and start taking a statin (ATORVASTATIN) and Aspiran.
A diet change will be to introduce vegetables/fruit/healthy fats ie: avocado, olive oil, nuts
Not happy about that.
I feel good but this has really shocked me.
Any thoughts or suggestions to reduce the risk is appreciated.
Thanks
Nick
Hi Nick
CAC Score: A calcium score of 797 is very high, indicating an elevated risk for coronary events. Given this score, your concern is understandable.
Cholesterol Levels: Your LDL-cholesterol (LDL-C) level of 5.3 mmol/L (205 mg/dl) is notably elevated. I recommend confirming these results with a repeat test and reviewing past cholesterol readings, even the first time you checked your cholesterol, if available. With consistently high LDL-C levels, I’d suggest using the Familial Hypercholesterolemia (FH) calculator to rule out FH. An LDL-C level as elevated as yours warrants intervention independent of the calcium score. This underscores why calcium scoring isn’t typically recommended for high-risk individuals. Even with a score of zero, I’d advocate for addressing such high LDL-C levels.
Dietary Considerations: The carnivore diet is naturally rich in saturated fats. Some research suggests a potential link between saturated fats and raised cholesterol levels. Diversifying your diet to include more fruits, vegetables, whole grains, and healthy fats is advantageous.
Medications: There’s substantial evidence supporting the efficacy of statins, like ATORVASTATIN, in reducing LDL-C levels and thereby decreasing the risk of heart attacks and strokes. Aspirin can be used for secondary prevention and, in some cases, primary prevention. However, balancing the benefits against the potential bleeding risk is essential.
Lifestyle: Persisting with, or even intensifying, your exercise regimen, combined with stress-reducing techniques, is undoubtedly beneficial.
Regular Check-ups: Considering your high calcium score, it’s important to have regular follow-ups with your Cardiologist to adjust treatment as needed.
Hope this addresses some of your concerns
I am 77 yo, 5’6″, 233#, status post RNY bypass 11/1998. Normal cholesterol levels (total 178). No diabetes. No pre-diabetes. Calcium score of 64. Three doctors have suggested I start statins. I am on no other medications (except Stelara for psoriasis). I eat well, exercise (3 modalities, 8x week). I am resisting starting statins because it seems their suggestions are from some formula the pharmaceutical companies have come up with. Am I misinterpreting this?
Thank you for sharing your concerns.
Although I do not generally recommend doing a calcium score above the age of 70, a score of 64 at 77 is considered mild and “acceptable for age”.
Starting medications should be a shared decision between you and your doctor, considering your preferences and treatment goals and being aware that there is a ton of “misinformation” online, especially about statins. Although your total cholesterol level is within the normal range, we don’t always prescribe statins based on cholesterol levels.
Diet and exercise certainly are pivotal components to improving cardiovascular health. Still, they may not be enough, especially in the presence of certain risk factors like age, obesity, family history, smoking, and hypertension, which may be the reasons why your doctors suggested statins. Statins play a crucial role in primary prevention – the steps we take to prevent illness before it starts. However, the benefits and risks can become harder to assess as we age. It is, therefore, essential to have open, detailed discussions with your healthcare provider about these factors when considering a treatment plan.
All considered, I would not be too concerned about a Calcium Score of 64 at the age of 77 if you have no symptoms, don’t smoke and have no other significant risk factors for a heart attack. On the other hand, I would not be too concerned about the “likely” side effects of a low-dose statin either, as they are mostly due to the Nocebo effect and are manageable.
This information should be used as a guide and does not replace a consultation with your healthcare provider.
Hello, I am 42 years old. CT test showed that my calcium score is 7.7 and Eccentric calcified plaque of proximal segment with minimal stenosis. I wanted to know your opinion
We should always interpret the coronary calcium score in the context of age; a score of 7.7 in a 42-year-old is significant, meaning that you have more coronary calcium than expected for your age.
However, your mention of ‘Eccentric calcified plaque with minimal stenosis’ suggests you have undergone a “CT Coronary Angiogram” rather than a simple “CT calcium scoring” test, as the former gives more detailed information, including the degree of stenosis.
Regardless, I encourage you to adopt healthy habits like regular exercise, a balanced diet, and abstaining from tobacco and excessive alcohol. Regular check-ups with your healthcare provider is also essential.
I’ve a blog post explaining the difference between “CT Calcium Scoring” and “CT Coronary Angiogram”, which might be helpful to you. However, online advice should never replace an in-person consultation with your healthcare provider, who has a comprehensive understanding of your medical history.
What a great forum! I’m a 57 yr old male, 6’1, 247. I found out a week ago my calcium score was 300, I immediately started to assume I was gonna drop dead any day. But after alot of reading and this site, I have a much btr perspective on the issue and have stopped thinking I’m going to die any day from a heart attack! WHEW! ,Lol.. Istarted statin therapy and of coarse changed my diet, stopped drinking, exercising at the gym daily. Thanks to all.
Thank you for sharing your journey. Hearing how you’ve transformed initial worry into positive, life-altering changes is genuinely inspiring. I’m glad our content could provide comfort and guidance.
Remember, your coronary artery calcium score isn’t a death sentence; it’s a wake-up call. You’ve answered that call brilliantly, adopting healthier habits and beginning statin therapy.
Your story is an important reminder that our health is mainly in our hands, and even seemingly daunting “numbers” can’t diminish our power to improve our well-being. Your experience is an invaluable motivator for others in similar circumstances.
I am a 57 year old white male who exercises regularly and eats a relatively healthy, though not perfect, diet. Today, I just received a total CAC score of 117 (113 of it from the left anterior descending). I am under the guidance of my physician and don’t have is evaluation of the results yet. Do you think a statin will be necessary?
Thank you for sharing your concerns. The Coronary Artery Calcium (CAC) score, also known as a heart scan or calcium score, is a useful diagnostic tool for assessing the amount of calcium in the walls of the arteries supplying the heart. A higher score indicates a higher amount of calcium and, consequently, a higher risk of heart disease.
Your score of 117 suggests that there is a moderate amount of calcification. The LAD artery is a critical vessel that supplies a significant portion of the heart muscle, so any blockage or calcium buildup in this artery is of particular concern.
However, to answer your specific question about whether a statin will be necessary:
CAC score in isolation isn’t definitive: While your CAC score provides valuable insight, it’s only one component of a comprehensive cardiovascular risk assessment. Other factors such as cholesterol levels, blood pressure, family history of heart disease, smoking status, and any presence of diabetes or other metabolic disorders play a significant role in the overall risk assessment.
Personalized treatment approach: Treatment decisions, including the use of statins, should be tailored to each individual’s unique risk profile and circumstances. It’s important to understand that not every person with a specific CAC score will benefit from the same treatment approach.
Discuss with your physician: While the CAC score is a valuable tool, It is essential to discuss your results and all the other risk factors with your physician to make an informed decision. She will have a holistic view of your health and will be in the best position to advise on the appropriate treatment approach, keeping in mind that statins significantly reduce the risk of cardiovascular events.
Hi Dr.,
My husband is 73 ys old. He plays hockey 3 to 5 games per week and is active with yard work, cutting down trees, lawn mowing, you name it. I am several years younger and he works circles around me sometimes. My husband recently has been having groin pain issues and neck pain on and off (more on lately) and last time he was at the Dr. they suggested a cac test. Well he went for it and his score was 2215! I am terrified and we have an appointment in 10 days but it can’t come soon enough. The general practice dr says he hasn’t seen a score like that. Any suggestions while we wait? He has stopped playing hockey and I put a halt on all other activities, but he is an active person and not one to just sit around. By the way, your article was very informing. Thank you
Thanks, Keely – A CAC score of 2215 is indeed high, implying significant coronary artery calcification. Although such a calcium score may suggest the potential for underlying coronary artery blockages, this is not always the case. It’s crucial to consult a cardiologist to determine the appropriate steps for diagnosis and management.
Keep in mind that your husband’s calcium score has likely been elevated for a very long time, and the fact that he doesn’t experience any symptoms or chest pain, even during physical activities, is a positive sign. It’s essential to manage stress and remain calm while waiting for the appointment. Your support will be invaluable to him.
hi I have recently been told i have a calcium score of 448 at 42 years old,, showing heavy burden of coronary artery atheroma but no significant stenosis, but a high Burdon of non obstructive atheroma, not really sure what all this means and should i be significantly worried
Hi Peter
“Non-obstructive atheroma” essentially indicates that the coronary arteries remain open at the moment, but they are at a heightened risk of becoming blocked. It’s similar to a vital mountain road where vehicles can move unimpeded, but large unstable rocks at the summit may tumble down and obstruct the path at any time. The rational approach would be to secure these unstable rocks to prevent blockage and closures.
You have a substantial amount of calcium located on the arterial wall, which doesn’t obstruct blood flow, but the risk of blockage is significant. To stabilize these plaques and minimize the risk of coronary obstruction, also known as a heart attack, we suggest using statins and aspirin (though this is debatable), maintaining a healthy lifestyle, engaging in regular exercise and physical activity, achieving a healthy BMI, and avoiding tobacco use.
Hi,
My husband is 41 and has a cac score of 58. He is otherwise healthy. The nurse at cardiology office said that was a perfect score, but I’m thinking she is wrong. He has minimal calcification in LAD. Would really appreciate another opinion. Thanks in advance
Hi Katie
Calcium scores must be evaluated alongside other risk factors, such as lifestyle choices, family history, and laboratory tests, to ensure a comprehensive understanding of the results. Relying solely on the calcium score without considering the broader context can be misleading. He falls within the 90th percentile for their age group when utilising the MESA calculator. This indicates that his calcium score is higher than 90% of men in their demographic, implying that the score is notably elevated.
Iam a 66 year old woman with a CAC score of 225 with the split mainly in the right oronary and left descending. My primary care doctor order this test due high cholesterol/high blood serum. He had taken me off cholesterol med 7 months ago and of course will be putting back on it. My question is,
should I see a cardiologist at this point?
Hi Bonnie
If you exercise regularly, are taking statins with an LDL-cholesterol at or below 70 mg/dl (1.8 mmol/L), and have no symptoms such as chest pain or shortness of breath on exertion, it is not necessary to urgently see a Cardiologist. However, your primary doctor is the most appropriate person to make a decision on this matter.
Hello Dr. I will be 44 in a month, 5,11.5 and 250 lbs. I just found out my calcium score was 446. I was beyond shocked, especially when I saw how few my age have scores even half that value. I am a little terrified. It feels like I have just been given a death sentence or at least told I won’t the next decade, let alone see my 70s and 80s. I don’t even know, if I shoud do any physical activity, like tennis, running, and calisthenics. I feel like I should have a defibrillator with me at all times a wearing a heart rate monitor. Anyway, I guess I am asking if i can still live a long time with a heart such as mine? Can I still be active in exercise and competitive sport? Im seeing my cardiologist in a few days, to talk about the result, but I am really panicking now. I cant stop crying actually.
Hi Dayne
I am sorry to hear that. I hope you have already seen your Cardiologist and are feeling better. It’s important to remember that there’s no need to panic about these results. Your Cardiologist will likely perform a functional test, such as a stress echocardiogram or Nuclear scan, to determine if there are any severe blockages. If not, you should be able to participate in any exercise you like. However, this is a wake-up call for you to focus on a healthy lifestyle, and your Cardiologist may recommend statin therapy. In cases like yours, I always check for Lp(a) levels in the blood as well. Fortunately, a defibrillator is not necessary for you.
Can you explain why you would look Lp(a) levels? What levels might reassure or be concerning? And when evaluating Lp (a) levels, what others lipid profile levels would be of interest in relationship to Lp (a)? Any ratios related to Lp(a)? Thank you for such an informative video and thoughtful responses in your comments section, learned from these too!
Thank you, Penny, and I’m pleased to know that the information provided is helpful. I am currently working on completing an article about Lp(a) and a corresponding video that will be uploaded to my YouTube channel. Subscribers will receive automatic notifications. Lp(a) has gained considerable interest and warrants a dedicated section for discussion.
Hi Dr.
I am 57 and my CAC score was 1009 with most of that in my LAD. It is just one test, but should I be worried? I have the data, but have not yet spoken with my cardiologist. I workout every day, have high cholesterol, and have been eating healthier and doing more cardio as a result.
Hi Stephen
A calcium score of 1009 is severely elevated, and the chance of “obstructive” coronary artery disease is high in this range. It is extremely important to note that a high calcium score should NOT automatically lead to angioplasty (Stenting of the arteries). Unfortunately, there have been many cases that patients with such scores have been directly referred for invasive coronary angiogram without any prior functional testing like stress echocardiogram or Myocardial Perfusion Scan (nuclear testing), depending on the local expertise and preference. I recommend seeing a Cardiologist with that score, even if you are asymptomatic BUT be wary of unnecessary angioplasty.
Thanks Doc! My cardiologist has scheduled a nuclear stress test and a lipid panel. I take Warfarin for a prosthetic, mechanical aortic valve, which I think has contributed to the calcium buildup. My doc wants me to take a statin, but I am wary of treating what may be the side effect of one drug with another drug that also has its own side effects. I will if I have to, but not until after my lipid panel.
BTW, this is a fantastic thing you are doing here!
Thank you, Stephen.
I highly recommend following your Cardiologist’s recommendations and starting a statin, even if your cholesterol level is in the normal range. Statins have other properties that help prevent a heart attack. They reduce the amount of fatty deposits in the arteries and stop the further build-up of such deposits. Statins also make existing deposits less likely to break off and cause a blood clot. Clots are the main culprits in heart attacks and strokes.
A blood clot can cause a heart attack or stroke.
I am 72 and have FH from my Father. I had my first Calcium Test in 2017, and last year had a 2nd CAC test plus a Heart Exercise Stress Test. All returned – ZERO (in fact the cardio specialist asked why I was there)!. I have never taken any statins and will not do any until a test suggests I should consider it. Seems that no-one has done any research that makes sense under these circumstances. I eat well and exercise often and I personally feel that the high cholesterol reading is just that my body is fine with it. Whilst it doesn’t yet put the cholesterol it where it isn’t wanted – I should not risk any affects from the statins.
Hi Valerie
You probably have high cholesterol; hence you did all those tests. Not knowing how high your LDL is, having a calcium score of zero at 72, is very reassuring. However, as I have mentioned in previous replies, the calcium score is only “one” small part of the decision-making process, and other significant risk factors should guide the decision. I’m assuming your Cardiologist has performed a calcium score to see how hard she should try to convince you to start Statin if it is high, or leave it, if it returns zero.
I’m 60, my CAC score is 36. My doctor recommended going on a statin. According to this online calculator https://www.calciumscorecalculator.com/ , I’m 32nd percentile for a white male like me. If I’m “better” than 62% of white guys, I can’t see going on a statin. Do you argee?
CAC score is only a tiny part of the equation and cannot (or should not) be used as the only factor to decide whether to start a Statin. For example, if you are a healthy, athletic 60-year-old with no other risk factor (like diabetes, smoking, hypertension, strong family history or high cholesterol), I would be pretty lenient regarding the initiation of Statin in your case. A truly “individualised” care that makes it impossible to have a blanket rule.
I am 64, my score is 919 and percentile is 92. Guess it is pretty high: no symptoms, daily vigorous exercise. Are the units used are all the same around the world?
Yes, same everywhere. A calcium score of 919 is considered “significantly” elevated.
Thanks, clear and logical explaination.
My score went from a zero to 32 in a span of 4 years. as a 60 year old male, should I be concerned?
Hi Matt, we should never look at “one single test” and try to estimate someone’s risk of heart attack. Coronary Calcium Score is only one part of the whole puzzle and should be interpreted along with many other risk factors as I have explained in this post. (How to reduce the risk of a sudden heart attack). If you have no other risk factor, a calcium score of 32 at 60, is quite acceptable but you need to discuss with your care provider.
very informative. Thanks
Thank you
Thank you. Very informative!
Glad it was useful.
This discussion and particularly the video was excellent. I have a family history of heart disease. Starting with my primary physician and the through screening programs offered by a local hospital I’ve had regular vascular, CT scans and calcium scores.
The results were interpreted for me by my primary physician, but frankly I never really understood what she was telling me. Your video was extremely helpful in understanding how plaque develops.
Have you made, or do you know of other videos related not the issues that I should understand related to “intervention” options that – base on my family history – will likely be needed at some point?
Thanks, Scott
I should say that Calcium scores and especially CT Coronary angiograms, do not need to be repeated often. With the current medications that we have available these days, most coronary artery diseases could be managed medically, with no interventions required. Interventions (like stents or bypass surgery) are largely recommended for people who have “symptoms” like chest pain. They do not necessarily “prevent a heart attack” but can improve symptoms. However, what will prevent a heart attack, is tight management of risk factors (with the addition of statins and Aspirin if needed) and a healthy lifestyle. Here you can read about Heart Attack Prevention.
Great review of the subject and video, thank you