Numbers can tell us plenty about our heart health and where it’s headed.
For some people, one key test is a coronary artery calcium (CAC) score. It measures calcium blockages in our heart vessels and determines the risk of developing heart disease as we age.
A high number suggests that dangerous plaque buildup is blocking sufficient blood flow.
“This test tells us whether or not to put a patient on aggressive medical therapy to help prevent heart attack, stroke or death,” said interventional cardiologist Dr. Don Yakel of Novant Health Heart & Vascular - Physicians Plaza in Hilton Head.
Calcium scores also help inform decisions around medications, diet and exercise. Starting at age 40, the American College of Cardiology recommends screening high-risk patients for coronary artery disease, the most common cause of heart failure.
Expertise to keep your heart strong and healthy.
Who should ask their primary care doctor about getting a calcium score? Candidates have two or more underlying risk indicators – like diabetes or high blood pressure – and experience symptoms including chest pain and shortness of breath.
But even asymptomatic patients should get screened if there’s a family history of diabetes or high blood pressure. Pregnant women and people who are regularly active, eat well and avoid smoking generally don’t need screening.
CAC score ranges are based on the risk of heart attack, stroke or death:
- 0 to 399 (mild plaque): low risk
- 400 to 999 (moderate plaque): moderate risk
- 1,000 and higher (severe plaque): high risk
Most Novant Health hospitals offer CAC score testing, though you’ll need a referral from your primary care provider to make an appointment.
Here, Yakel addresses common concerns about what to expect.
What’s so bad about calcium? Don’t we need it for our bone health?
Yes, 100%. Calcium is supposed to be in your bones, but not in your heart arteries. Atherosclerosis (a cause of coronary artery disease) is the fat, cholesterol and calcium that builds up in the arteries.
There are several scenarios for different patients: You can have a little bit of calcium and also have bad blockages. You can have a lot of calcium and not have bad blockages. But like every other risk factor for heart disease, the more calcium you have in the heart arteries, the greater the chance of blockages.
What is the coronary artery calcium test looking for?
The tool screens for hardening of the arteries. Depending on relative risk factors – such as high blood pressure, high cholesterol, smoking and family history – screenings help us define whether a patient should be treated with primary prevention (getting ahead of a disease before it occurs) or secondary prevention (reducing the impact of an existing disease).
A zero calcium score falls under primary prevention, which means we would not pursue medical therapy. But for an existing disease, we work to prevent complications of the existing disease by pursuing either baby aspirin therapy or statin therapy to prevent plaque buildup.
Does a zero score mean I’m in the clear?
It only means you’re in the clear at that time. It does not mean that you can’t develop a disease later. The number itself doesn’t necessarily mean anything other than whether or not I should treat underlying high blood pressure and elevated cholesterol more aggressively. If an asymptomatic patient registers a severe score (above 1,000), that also helps me determine whether more testing is necessary.
How do you talk to patients who score in the severe range, and can they bring that score down?
We lean into conversations around a more aggressive diet, exercise therapy and GLP-1 weight-loss drugs. We also talk about the risks, benefits and alternatives of baby aspirin therapy and statin therapy. There is no proven way to reverse coronary artery disease. Once you have it, it’s not curable. So the calcium scores are not likely to get better. But with aggressive treatment and lifestyle changes, you can stabilize them and keep them from getting worse.
Is there a risk of radiation exposure from a scan?
The amount of radiation exposure is less than what you’d receive during a day of sitting next to a window (about the same as a mammogram). The scan is just a high-powered X-ray. There’s no IV or iodine. You jump up onto the table, the CT scanner buzzes, and you’re done within 15 minutes.
