The Coronary Artery Calcium (CAC) score measures calcified plaque in the heart’s arteries, indicating atherosclerosis (hardening of the arteries). This non-invasive computed tomography (CT) scan quantifies calcium deposits, which form part of the overall plaque burden. The resulting Agatston score is an independent predictor of a person’s future risk for a heart attack or stroke. Physicians use this score, particularly for individuals with intermediate risk, to guide decisions regarding preventive medical therapies and lifestyle changes. A score of zero indicates very low risk, while higher scores correlate with progressively greater risk of a cardiovascular event over the next decade.
Understanding the Score: Why Lowering Is Misleading
The common question of how to lower the CAC score stems from a misunderstanding of what the number truly represents. The score measures existing, hardened calcium deposits accumulated within the arterial wall over many years. Once soft, fatty plaque calcifies, it becomes scar tissue that is difficult, if not impossible, to dissolve or reverse with current medical treatments.
Therefore, the goal of treatment shifts away from physically reducing the score itself. The focus is instead on two achievable objectives: slowing the rate at which new calcification forms and stabilizing the existing plaque. Intensive lipid-lowering therapies may initially cause a slight score increase as soft, vulnerable plaque components are reduced, leaving fixed calcium behind. This stabilization process significantly reduces the risk of plaque rupture, the immediate cause of most heart attacks.
Essential Lifestyle Changes to Halt Progression
Adopting a heart-healthy lifestyle halts the progression of atherosclerosis and prevents new calcified plaque formation. Dietary adjustments should align with the Mediterranean or DASH (Dietary Approaches to Stop Hypertension) eating plans. This involves reducing saturated fats, trans fats, and processed foods, which contribute to inflammation and cholesterol accumulation. Increasing soluble fiber intake (10 to 25 grams per day) helps manage cholesterol levels effectively.
Physical activity improves endothelial function and lowers blood pressure. Current recommendations suggest a minimum of 150 minutes of moderate-intensity aerobic exercise each week. Combining this with resistance training enhances overall fitness and helps manage cardiovascular risk factors. Consistent exercise is linked to a slower rate of CAC progression.
For individuals who use tobacco products, smoking cessation is the most impactful intervention for halting coronary calcification. Tobacco smoke directly damages the inner lining of the arteries, accelerating inflammation, plaque formation, and instability. Eliminating this habit reduces both the incidence and progression rate of atherosclerotic disease.
Maintaining a normal body weight, typically defined by a Body Mass Index (BMI) below 25, is foundational for risk reduction. Excess weight, especially around the waist, is associated with increased inflammation, higher blood pressure, and impaired glucose metabolism, all of which drive calcification. The benefits of these lifestyle measures are cumulative, increasing protection against future cardiac events.
Clinical Treatment Strategies for Stabilizing Plaque
Medical treatment controls systemic conditions that fuel plaque growth and instability. Cholesterol management, primarily using statins, is central for patients with an elevated CAC score. These lipid-lowering drugs reduce low-density lipoprotein (LDL) cholesterol, decreasing the size of the plaque’s soft, lipid-rich core. This stabilizes existing atherosclerotic lesions by strengthening the fibrous cap, making rupture less likely.
Managing high blood pressure is equally important, as uncontrolled hypertension stresses arterial walls, promoting damage and plaque formation. Medications like ACE inhibitors or beta-blockers help maintain target blood pressure levels. Controlling pressure reduces mechanical strain on the coronary arteries, slowing arterial injury and the inflammatory response.
For individuals with diabetes, achieving tight glucose control is necessary due to the strong correlation between high blood sugar and accelerated coronary calcification. Physicians may also discuss adjunctive therapies, such as Vitamin K2 supplementation, which regulates where calcium is deposited. These emerging therapies are being investigated for their potential to modify the underlying disease process, though they are not a substitute for established risk factor management.
Long-Term Monitoring and Next Steps
After initiating lifestyle changes and medical therapies, consistent monitoring ensures the plan’s effectiveness. This includes regular follow-up blood work to check lipid panels, A1C levels for glucose control, and blood pressure measurements. These tests track the modification of underlying risk factors, which is the true measure of treatment success.
Repeating a CAC scan is typically not done immediately, as short-term changes are minimal. Since the procedure involves radiation exposure, physicians generally recommend waiting several years (often five to ten) before a re-scan to re-assess long-term risk and progression rate. This timing is individualized based on the initial score and the patient’s overall risk profile.
Maintaining open communication with a cardiologist or primary care physician is important. The CAC score provides a specific, objective number for personalized risk assessment. The healthcare team uses this information, combined with the patient’s health history, to tailor a strategy focusing on plaque stabilization and cardiovascular risk reduction.