Who Should Find Out Their Coronary Calcium Score, and Why?

Would that knowledge inspire you to modify your habits in hopes of changing your risk?

A coronary calcium scan is a noninvasive imaging test that can reveal your risk for a heart attack within the next 10 years, which can help you improve your long-term health. This screening is available to adults who are at moderate risk of heart disease.

“A coronary calcium scan personalizes the idea of your risk assessment and prevention, because it’s about your own heart and arteries,” said Paul Marano, MD, a Cedars-Sinai cardiologist. “People are thinking about prevention more, and calcium scans can be an important tool. It’s a picture of what’s happening under the surface, and it helps inform lifestyle practices and medication.”

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Why Get a Coronary Calcium Scan?

Heart disease is the number-one cause of death among Americans. Early heart disease has no symptoms, so many patients miss out on preventive care that can change the trajectory of their health.

A coronary calcium test is a CT scan that can detect calcium buildup inside the arteries that lead directly to the heart, the coronary arteries. Calcium buildup is one of the earliest signs of coronary artery disease. Plaque buildup narrows arteries and makes it hard for blood to reach the heart, which can lead to heart attack, stroke or heart failure.

“When plaque develops and gets into the artery wall, there’s inflammation,” Marano said. “Over time, the body breaks down that plaque, and calcium develops as part of that healing process. It’s a marker of plaque that’s been there.”

The test can prompt important conversations between doctors and patients.

“The results are often a wake-up call—a way for people to be serious about preventive measures they can take for their health,” Marano said. “Your lipid or high blood pressure numbers are less tangible. Seeing your own heart arteries with calcium is different.”

What Happens During a Coronary Calcium Scan?

You don’t need a doctor’s referral to get a coronary calcium scan at Cedars-Sinai, but it’s helpful to discuss your test results with a doctor.

During the test, you’ll lie down and stay still for a 10-minute CT scan of your heart.

Because it’s a CT scan, it emits a low dose of radiation, like a mammogram, Marano said.

The results of a coronary calcium scan are often a wake-up call—a way for people to be serious about preventive measures they can take for their health.

Who Should Get a Coronary Calcium Scan?

A coronary calcium scan is intended for people at moderate risk of heart disease, rather than high or low risk.

“It’s useful for people in that gray zone, and a lot of people fall into that bucket,” Marano said.

Unlike a mammogram or colonoscopy, which are mostly universally recommended to everyone at a certain age, a coronary calcium scan is usually offered after a holistic evaluation finds a person is at moderate risk for developing heart disease.

Before ordering the test, a doctor will consider your age and several health factors. The screening test may be appropriate if you’re a man over 45 or a woman over 55 and you have:

• High blood pressure
• High cholesterol
• A family history of heart disease
• Diabetes
• Obesity
• Chronic high stress
• Smoking
• Physical inactivity

What Is a Calcium Score?

The results of your coronary calcium scan are expressed as a number, known as your calcium score. It reflects the amount of calcium in your coronary arteries.

A calcium score of zero means there’s no calcified plaque in your coronary arteries, and your risk of heart attack in the next 5 to 10 years is low.

“In studies, a zero calcium score is predictive of having a very low rate of heart attacks over the short to medium term,” Marano said. “That can help inform your therapy, medications and lifestyle, and also give you some reassurance.”

Any calcium present means you have some degree of coronary artery disease. A score above 100 means that you have a significant amount of calcified plaque, and your doctor will likely prescribe a statin to help lower your cholesterol.

“As that score gets higher, your risk for cardiac events gets higher,” Marano said. Some studies at the population level suggest the addition of low-dose baby aspirin to the statin when the score gets above 400.

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Treatments After a Coronary Calcium Scan

Doctors often order calcium scans because they’re unsure whether patients need statins.

“The results can push the decision one way or the other,” Marano said. “If we see some plaque, a statin could be useful to prevent it from progressing.”

Regardless of your calcium score, doctors recommend heart-healthy lifestyle habits, including a modified diet and exercise, to everyone. Even if your score suggests your risk is low, you should lower stress, stop smoking and decrease your alcohol intake.

The American Heart Association recommends you get 30 minutes of aerobic exercise five times a week (150 minutes total), include muscle-strengthening activities twice a week, and spend less time sitting.

“Getting the recommended exercise is easier said than done,” Marano said, “but having evidence of your own calcium score can help you prioritize yourself among all your other priorities.”

The AHA also recommends you eat a Mediterranean-style diet, which is high in fruits and vegetables, legumes, lean protein and unsaturated fats, and low in saturated fats and salt.

“We have some data that the Mediterranean diet can decrease the risk of heart attack over time,” Marano said. “But a lot of people who make drastic changes keep it up for only a couple of weeks or months, because it’s not fitting with their lifestyle. The diet that’s best for the patient will be the diet that’s sustainable for them.”