The Coronary Calcium Score (CCS) is a non-invasive tool that assesses the long-term risk of a heart attack or stroke. The score is derived from a specialized computed tomography (CT) scan that looks for calcified plaque buildup in the coronary arteries. Patients often ask whether this number can be lowered through medical intervention or lifestyle changes. While the numerical score is generally considered permanent, a high score is not a final verdict, and the focus shifts to aggressive strategies for reducing the risk of a future cardiac event.
What the Coronary Calcium Score Measures
The Coronary Calcium Score, often referred to as the Agatston score, quantifies the amount of established, calcified plaque in the walls of the heart’s arteries. Atherosclerosis involves waxy cholesterol deposits that eventually harden into calcium, similar to bone. The CT scan detects these dense calcium deposits and calculates the score based on the area and density of the calcification.
The resulting Agatston score ranges from zero to over a thousand, with each range carrying a different risk profile. A score of zero indicates no detectable calcified plaque and suggests a very low chance of a heart attack over the next decade. Scores between 1 and 100 represent minimal to mild plaque burden, signaling the presence of disease and warranting risk factor management. A score greater than 400 signifies an extensive amount of calcified plaque and is associated with a significantly higher risk of a coronary event.
Why the Score Number Cannot Be Reduced
The Coronary Calcium Score cannot be reduced because of the physical stability of the calcium deposits it measures. Once calcium is incorporated into atherosclerotic plaque, it forms a fixed, hard mineral structure within the arterial wall. Current medical science and pharmacological treatments lack the ability to dissolve or remove this established calcification.
The numerical score serves as an historical marker of the lifetime burden of atherosclerosis. Aggressive medical therapies designed to stabilize plaque may even slightly increase the score over time. This occurs because treatments reduce the soft, fatty core of the plaque, leaving behind a smaller, more densely calcified, and stable lesion. This stabilization is beneficial because the lesion is less likely to rupture and cause a heart attack. The focus must shift from lowering the score to stabilizing existing plaque and preventing the formation of new calcification.
Medical Management to Slow Plaque Progression
Individuals with a non-zero CCS require aggressive medical management aimed at halting the progression of atherosclerosis and stabilizing existing plaque. Medications address underlying risk factors that fuel the disease, such as high cholesterol, hypertension, and diabetes. Statins, which are HMG-CoA reductase inhibitors, are a cornerstone of this treatment, lowering low-density lipoprotein cholesterol (LDL-C).
The goal of statin therapy is often to achieve an LDL-C level below 70 mg/dL, which helps reduce inflammation and stabilize the soft, non-calcified components of the plaque. For patients with high blood pressure, antihypertensive agents like ACE inhibitors or ARBs are prescribed to maintain blood pressure below 130/80 mmHg, reducing mechanical stress on arterial walls. Managing blood sugar is also important for those with diabetes, typically targeting a hemoglobin A1c (HbA1c) below 7%. In higher-risk cases, newer cholesterol-lowering drugs, such as PCSK9 inhibitors, may be added to further reduce lipid levels and mitigate disease progression.
Lifestyle Interventions for Cardiovascular Health
Lifestyle modifications are the foundation of managing cardiovascular risk and work synergistically with prescribed medications. Adopting a heart-healthy dietary pattern, such as the Mediterranean diet, involves prioritizing fruits, vegetables, whole grains, and healthy fats while significantly limiting saturated fats and sodium. This nutritional approach helps to improve endothelial function and reduce systemic inflammation.
Regular physical activity is highly effective, with guidelines recommending at least 150 minutes of moderate-intensity aerobic exercise weekly. Exercise helps manage weight, improve cholesterol profiles, and lower blood pressure, all of which slow the overall disease process. The single most impactful lifestyle change is absolute smoking cessation, as tobacco use severely damages the arterial lining and accelerates plaque buildup and instability. These changes, along with maintaining a healthy weight, are powerful tools for reducing the likelihood of a future cardiovascular event, even if the calcified score remains unchanged.