A high coronary artery calcium (CAC) score indicates calcified plaque in the heart’s arteries, signaling atherosclerosis. Statins are medications commonly used to manage cholesterol levels and reduce cardiovascular events. For individuals with elevated calcium scores, statins help mitigate arterial disease progression and lower the likelihood of future heart issues.
Understanding a High Calcium Score
A coronary artery calcium (CAC) score is a measurement from a non-invasive computed tomography (CT) scan of the heart. This scan detects and quantifies calcified plaque within the coronary arteries. Calcium deposits indicate atherosclerosis, where fatty plaques build up, narrowing arteries and impeding blood flow. A higher calcium score suggests a greater extent of plaque buildup and arterial disease.
Scores typically range from zero to over 1,000, with zero indicating no calcified plaque and a low risk of future cardiovascular events. A score between 1 and 99 suggests mild disease. Scores from 100 to 399 indicate moderate plaque and a high risk of heart attack or heart disease within three to five years. A score exceeding 400 signifies a large amount of plaque and a high probability of a cardiovascular event. This score is a strong predictor of future heart attacks and strokes, even in individuals without symptoms.
How Statins Address Arterial Calcification
Statins primarily function by inhibiting an enzyme in the liver called HMG-CoA reductase, involved in cholesterol production. This action reduces low-density lipoprotein (LDL) cholesterol, or “bad” cholesterol, in the bloodstream. By lowering LDL cholesterol, statins help to decrease new plaque accumulation in the arteries.
Beyond cholesterol-lowering, statins possess anti-inflammatory properties that stabilize existing plaques. They can modify atherosclerotic plaque composition, reducing their lipid-rich core and increasing calcification and fibrous content. This transformation makes plaques less prone to rupture, a common cause of heart attacks and strokes. While statin therapy may paradoxically increase the coronary artery calcium score over time, this rise often reflects a favorable change in plaque microarchitecture, indicating increased plaque stability rather than continued disease progression.
Selecting Statins for High Calcium Scores
For a high coronary artery calcium score, high-intensity statins are generally preferred due to their potent LDL-lowering capabilities and proven efficacy in reducing cardiovascular events. Atorvastatin and rosuvastatin are examples often chosen. These medications significantly reduce LDL cholesterol, with high-dose atorvastatin (80 mg) lowering LDL cholesterol by about 73 mg/dL after one year, compared to about 46 mg/dL with lower-dose statins.
The selection of a specific statin and its dosage is individualized, considering a patient’s overall cardiovascular risk factors, other medical conditions, and potential drug interactions. Clinical guidelines suggest initiating statin therapy for individuals with a CAC score of 100 or higher, regardless of other risk factors, to manage the risk of future cardiovascular events.
Beyond Statin Choice: Comprehensive Management
Managing a high coronary artery calcium score involves a comprehensive approach to cardiovascular health. Lifestyle modifications are important. Adopting a heart-healthy diet, regular physical activity, and maintaining a healthy weight are key steps.
Quitting smoking is highly recommended, as it significantly reduces cardiovascular risk. Controlling other risk factors like high blood pressure and diabetes is also essential.
For individuals with very high calcium scores (e.g., over 1000), healthcare providers may consider adding non-statin therapies like ezetimibe, PCSK9 inhibitors, inclisiran, or bempedoic acid to achieve even lower LDL cholesterol targets, sometimes aiming for levels below 55 mg/dL. Regular consultation with a physician is necessary to develop a personalized treatment plan and ensure ongoing monitoring and adjustments as needed.