A high Coronary Artery Calcium (CAC) score indicates a significant accumulation of calcified plaque within the arteries supplying blood to the heart. This score is obtained through a specialized, non-invasive imaging test designed to assess an individual’s long-term risk of a cardiovascular event. The presence of this hardened material is a direct marker of atherosclerosis, or coronary artery disease. Atherosclerosis is the underlying cause of most heart attacks and strokes. Understanding this score allows for the implementation of targeted strategies to modify future health outcomes.
Understanding the Coronary Artery Calcium Score
The Coronary Artery Calcium scoring uses a computed tomography (CT) scan of the heart. This non-invasive procedure does not require intravenous contrast dye and typically takes only a few minutes, involving minimal preparation. The CT scan specifically measures calcium deposits in the walls of the coronary arteries, which feed the heart muscle.
The calcium measured is the hardened shell of atherosclerotic plaque, confirming the existence of long-term disease within the arteries. Plaque is a waxy substance made of cholesterol, fat, and other materials; calcification is a late-stage marker of this disease process. Although the test does not directly measure soft, non-calcified plaque or the extent of arterial narrowing, the amount of calcified plaque correlates strongly with the total atherosclerotic burden and future cardiac risk.
Interpreting the Numerical Risk Scale
The CAC scan result is reported as the Agatston score, calculated based on the density and total area of detected calcium deposits. Healthcare providers use this score to stratify an individual’s risk of a heart attack, stroke, or cardiovascular death over the next decade. The higher the score, the more extensive the underlying coronary artery disease and the higher the risk for a future cardiac event.
A score of zero is the best result, indicating no identifiable calcified plaque and an extremely low risk of a coronary event, often less than 5% over a decade. This finding suggests that pharmacologic interventions like statins may be deferred, allowing a focus on lifestyle modification. Scores between 1 and 100 represent a mild plaque burden and a low-to-moderate risk, suggesting mild coronary artery disease is present.
A score between 101 and 400 is considered a moderate plaque burden, placing the individual in a moderate-to-high risk category. This level often warrants a detailed discussion with a healthcare provider about initiating preventive therapies. When the score exceeds 400, or even 1,000, it indicates an extensive burden of calcified plaque, signifying a high or very high risk of a future event.
Scores over 400 are associated with a high likelihood of significant coronary artery narrowing, and the 10-year event rate can be substantial. For individuals in this high-risk category, aggressive preventive interventions are recommended. The Agatston score serves as a prognostic tool, offering more precise risk prediction than traditional risk factors alone, particularly when risk was previously uncertain.
Medical Management Following a High Score
A high CAC score (typically 100 or greater) necessitates a comprehensive medical evaluation and consultation with a cardiologist to establish an aggressive management plan. The primary goal is to stabilize existing plaque and reduce the risk of rupture that could lead to a heart attack. This approach focuses on aggressively controlling risk factors through pharmacological means.
Pharmacological interventions commonly include statins, medications that lower low-density lipoprotein (LDL) cholesterol. For individuals with a high score, especially above 300, aggressive statin therapy is recommended regardless of baseline cholesterol levels to achieve a lower LDL-C goal (often less than 70 mg/dL). Statins work by altering the composition of the plaque, often leading to a paradoxical increase in the calcium score as the plaque becomes denser and more stable.
Beyond statins, other medications may be prescribed. These include anti-platelet agents like low-dose aspirin, which reduce the risk of blood clots forming on existing plaque. Blood pressure medications are frequently adjusted to lessen the strain on arterial walls, and diabetes management is intensified if high blood sugar is present. A high CAC score may also prompt further diagnostic testing, such as a stress test. This determines if the calcification is causing functional impairment or insufficient blood flow to the heart muscle.
Actionable Lifestyle Strategies
A positive CAC score serves as a motivator for implementing significant lifestyle changes that work in conjunction with medical therapy to reduce overall cardiovascular risk. Quitting all forms of tobacco use is the single most impactful change, as smoking accelerates plaque formation and damages the arterial lining. A healthy diet, such as the Mediterranean diet, should be adopted, emphasizing fruits, vegetables, whole grains, and healthy fats while limiting saturated fats, sodium, and added sugars. Regular physical activity is a primary element of prevention, generally suggesting at least 150 minutes of moderate-intensity aerobic exercise per week. Exercise strengthens the heart and helps manage blood pressure, cholesterol, and weight, all independent risk factors for coronary artery disease.
Maintaining a healthy body weight and proactively managing chronic conditions like hypertension and diabetes are necessary components of a comprehensive risk reduction strategy.