What Calcium Scores Indicate
A coronary artery calcium (CAC) score is a measurement obtained through a specialized computed tomography (CT) scan. This non-invasive CT scan detects and quantifies calcium deposits within the heart’s arteries. These calcium deposits are an early and specific sign of atherosclerosis, a condition where plaque builds up and hardens the arteries, potentially leading to narrowed or blocked blood vessels.
The calcium score, often referred to as an Agatston score, ranges from zero to over 1,000, with higher scores indicating a greater extent of calcified plaque. A score of zero suggests no calcified plaque and a very low risk of a heart attack in the near future. Scores between 1 and 99 indicate mild calcification, while scores from 100 to 399 signify moderate plaque deposits. A score of 400 or greater points to severe calcification. Generally, a higher score correlates with a greater burden of plaque buildup and a correspondingly increased risk of future cardiovascular events like heart attack or stroke.
Interpreting a Score of 600
A coronary artery calcium score of 600 signifies extensive and severe atherosclerosis. This level of calcification places an individual in a very high-risk category for significant cardiovascular events. Individuals with a score of 600 have a markedly increased likelihood of experiencing a heart attack, stroke, or other cardiovascular diseases within the next 5 to 10 years compared to those with lower scores. This score is often considered equivalent to having established coronary artery disease, even in the absence of overt symptoms. While a high score indicates significant risk, it does not mean an event is imminent.
A score exceeding 400, including a 600, strongly suggests that aggressive risk factor management strategies are necessary. For example, a score of greater than 400 is associated with a more than 90 percent chance that plaque is blocking at least one artery. In some studies, scores greater than 300 have been associated with 10-year event rates for cardiovascular disease ranging from 13.1% to 25.6%.
Next Steps After a High Score
Receiving a high coronary artery calcium score like 600 necessitates immediate consultation with a healthcare professional. This discussion will focus on understanding the implications of the score and developing a personalized management plan.
Further diagnostic tests are typically recommended to provide a comprehensive picture of cardiovascular health and identify other contributing risk factors. These may include blood tests to assess lipid levels, such as LDL (“bad”) cholesterol, and blood sugar levels to check for diabetes. Blood pressure checks and stress tests, which evaluate how the heart performs under exertion, are also common next steps. In some cases, a coronary CT angiogram (CCTA) might be considered to visualize the actual blockages, although high calcium scores can sometimes make CCTA interpretation challenging.
Medical interventions often include the initiation of medications like statins to lower cholesterol, which help stabilize existing plaque and prevent further buildup. Blood pressure medications may also be prescribed if hypertension is present, to reduce strain on the arteries. Lifestyle modifications will be introduced as a key part of the treatment strategy.
Ongoing Management and Prevention
Long-term management following a high calcium score focuses on sustained strategies to mitigate cardiovascular risk. Lifestyle changes form a cornerstone of this approach, aiming to slow the progression of atherosclerosis. Dietary modifications, such as adopting a heart-healthy eating pattern rich in fruits, vegetables, and whole grains while limiting saturated fats, are important.
Regular physical activity is encouraged, with a goal of at least 150 minutes of moderate-intensity exercise weekly, to strengthen the heart and manage related risk factors. Smoking cessation is an important step, as smoking damages arteries and accelerates plaque formation. Weight management and stress reduction techniques also contribute to overall heart health.
Medical management involves adherence to prescribed medications and regular follow-up appointments. Statins and other medications help manage cholesterol, blood pressure, and blood sugar levels, aiming to stabilize plaque and reduce the risk of adverse events. While existing calcium deposits cannot be removed, diligent management can significantly slow the progression of calcification and reduce the overall risk of heart attack or stroke.