What does your coronary calcium score mean

A heart CT can give you and your doctor more information about your risk for coronary artery disease — even if you don’t have symptoms.

A coronary calcium test, also called a coronary artery calcium (CAC) scan, looks for calcium in plaque within the arteries that supply blood to your heart. The results produce a coronary calcium score, or CAC score, that can help your doctor better understand your risk and decide whether lifestyle changes, medication or other preventive steps may be helpful.

You may also hear the test referred to as a cardiac calcium scan or heart scan. If you have certain risk factors, such as high blood pressure or high cholesterol, your doctor may recommend a coronary calcium test to help guide your care.

What is a coronary calcium test?

A coronary calcium test is a type of heart CT that looks for calcium deposits in plaque within your coronary arteries. Calcium in these plaques is a sign of atherosclerosis, or hardening of the arteries.

Doctors may recommend the test when someone’s risk of developing coronary artery disease isn’t clearly low or high, according to Leila Haghighat, M.D., a cardiologist with Sutter. For example, your doctor might recommend a coronary calcium test if you don’t have signs of heart disease but do have certain risk factors and the results could help guide decisions about preventive treatment.

The scan is quick and noninvasive, and it doesn’t require contrast dye injected into your veins.

“It’s painless and straightforward,” Haghighat says.

What your coronary calcium score means

After your coronary calcium test, you’ll receive a coronary calcium score, also called a CAC score. In general, a higher score means more calcified plaque is present in your coronary arteries. Your doctor will consider your score along with other information about your health to better understand your risk and determine what steps may be appropriate for you.

Your results can also show where calcified plaque is located within your coronary arteries.

“Your sum score is the most important thing,” Haghighat says. “Many studies show that your coronary calcium score is predictive of your risk of heart attack or stroke five to ten years after the scan is obtained. When we look at the score, it can help us determine what your target cholesterol goal should be.”

This CAC score scale from the American Heart Association can help you learn more about the risk associated with your score:

• 0: Risk absent
• 1–9: Risk minimal
• 10–99: Risk mild
• 100–299: Risk moderate
• 300–999: Risk severe
• ≥1000: Risk extensive

Your CAC score is only one part of the picture. Your doctor will consider it along with factors such as your cholesterol, blood pressure, family history and overall health when recommending next steps.

What happens after the scan

Your coronary calcium score can help you and your doctor make more informed decisions about how to protect your heart health.

Heart-healthy habits, including eating a nutritious diet and getting regular physical activity, remain important regardless of your score. Depending on your CAC score and other risk factors, your doctor may also recommend a statin. Statins are prescription medications that lower LDL, or “bad,” cholesterol and can reduce the risk of heart attack and stroke.

“I usually want to see a patient back about three months after starting a statin, and I would request a repeat cholesterol test to see how it’s working,” Haghighat says.

If you have side effects or have trouble tolerating a statin, talk with your doctor. Adjusting the medication or trying another cholesterol-lowering treatment may be an option. Other medications include pills such as ezetimibe or bempedoic acid and injectable medications such as PCSK9 inhibitors.

The bottom line

Men age 40 and older and women age 45 and older may be considered for coronary calcium testing, particularly when their heart disease risk isn’t clear and the results could help guide a decision about preventive treatment.

A coronary calcium test isn’t right for everyone. For example, people who have symptoms such as chest pain or who already have known coronary artery disease may need other types of testing. Your doctor can help you decide whether a coronary calcium test would provide useful information for your care.

Haghighat compares it to other preventive screening tools.

“Think of a coronary calcium test as a mammogram for your heart,” she says. “It’s a simple test that can provide more information to help you manage your health.”