A Coronary Artery Calcium (CAC) score is a numerical measure derived from a non-invasive computed tomography (CT) scan of the heart. It detects and quantifies calcified plaque within the walls of the heart’s arteries. This score, often called the Agatston score, indicates the extent of atherosclerosis, the underlying disease of hardened arteries. The presence of calcium confirms coronary artery disease is present, even in people without symptoms. A higher CAC score is a strong predictor of a person’s future risk for a heart attack or stroke, making it a powerful tool for guiding preventive health strategies.
Understanding Coronary Artery Calcification
Coronary artery calcification is an active, regulated biological process that occurs as part of atherosclerosis. Atherosclerosis begins with injury to the artery wall, followed by the buildup of fatty deposits, cholesterol, and inflammatory cells, which form plaque. Over time, the body initiates a process similar to bone formation, causing calcium phosphate crystals to be deposited into the arterial wall.
The calcium measured by the CAC score is primarily found in older, more stable plaque, where the deposits wall off the fatty core. This contrasts with non-calcified, or “soft,” plaque, which is often considered unstable and prone to rupture, leading to a sudden heart event. While calcification correlates with the total plaque burden, the score measures only these stable deposits. A high CAC score signifies extensive disease and risk, even though calcified plaque is less likely to rupture than soft plaque.
The Direct Answer: Can the Physical Score Be Lowered?
The clear answer to whether the physical CAC score can be lowered is generally no, based on current medical practice and understanding of vascular biology. Once calcium is incorporated into the arterial wall’s fibrous matrix, it is considered a permanent part of the plaque structure. The goal of treatment is not to reduce the physical number on the scan but to prevent the score from increasing further.
The permanence of the calcium means that repeat CAC scans are typically not used to monitor treatment effectiveness. The score is highly unlikely to decrease and may even increase despite successful therapy. Interventions that stabilize plaque, such as statin therapy, may cause the calcification process to continue or slightly accelerate as the plaque converts from soft to more stable, dense calcium. The clinical focus remains on stabilizing existing plaque and managing underlying risk factors to minimize the chance of a cardiac event.
Some experimental treatments have explored reducing calcification, such as certain chelation therapies combined with antibiotics in small studies. One example involves using EDTA-tetracycline chemotherapy, which demonstrated a score decrease for a subset of patients in an older trial. However, these methods are not integrated into mainstream cardiology guidelines and require extensive research before they could be considered a standard approach for score reversal.
Strategies to Halt Calcification Progression
Since reversing existing calcium deposits is not feasible, the primary strategy after receiving a positive CAC score is to halt the progression of calcification and stabilize atherosclerotic disease. Lifestyle modification is the first and most impactful step to prevent the score from rising. This involves a comprehensive overhaul of daily habits that contribute to cardiovascular risk.
Dietary Changes
Dietary changes should prioritize a heart-healthy pattern, such as the Mediterranean diet, which emphasizes fruits, vegetables, whole grains, and healthy fats. Specific goals include reducing saturated fats and increasing soluble fiber consumption to manage cholesterol levels. These modifications directly address the lipid accumulation that fuels plaque growth.
Physical Activity
Regular physical activity is a cornerstone of prevention, helping to improve blood pressure, manage weight, and control blood sugar. Guidelines recommend aiming for at least 150 minutes per week of moderate-intensity aerobic exercise, such as brisk walking or swimming. Regular activity significantly reduces cardiovascular event risk, regardless of the score’s number.
Smoking Cessation and Metabolic Control
Smoking cessation is the single most important action for individuals with coronary calcification. Tobacco smoke damages the lining of the arteries, accelerating the formation and instability of plaque. Aggressive management of body weight and blood sugar is also imperative, especially for those with diabetes, as these metabolic conditions promote the inflammatory pathways that drive calcification progression.
Medical Management of Associated Cardiovascular Risk
Once a significant CAC score is detected, physicians typically initiate pharmacological management in conjunction with lifestyle changes. The goal of these medications is not to dissolve the calcium but to stabilize the plaque, lower the risk of rupture, and manage systemic conditions that accelerate artery damage.
Statin therapy is frequently prescribed because these drugs are highly effective at lowering low-density lipoprotein (LDL) cholesterol, a primary component of atherosclerotic plaque. Statins also have powerful anti-inflammatory effects that help stabilize existing plaque, making it less likely to rupture and cause a heart attack. This stabilization is a major benefit, even if the medication does not reduce the calcium score itself.
Managing blood pressure is equally important, as uncontrolled high blood pressure places significant strain on the arterial walls, promoting plaque progression. Medications like ACE inhibitors, ARBs, or beta-blockers are used to achieve target blood pressure levels. Low-dose aspirin therapy may also be recommended in certain cases to prevent blood clots from forming on existing plaque, though this decision is weighed against the risk of bleeding.