A coronary artery calcium (CAC) score is a measurement derived from a non-invasive computed tomography (CT) scan that quantifies the amount of calcified plaque in the arteries supplying the heart. Receiving a high score can be alarming, but it serves as an early, powerful predictor of future cardiac events. This measurement confirms the presence and extent of subclinical atherosclerosis, the underlying disease process that leads to heart attacks and strokes. A high CAC score is an opportunity to significantly reduce your long-term cardiovascular risk through immediate and sustained action.
Interpreting Your Calcium Score Result
The CAC score numerically represents the severity of calcium buildup in your coronary arteries. The results are categorized into four main ranges, each corresponding to a different level of risk. A score of zero indicates no detectable calcification and is associated with a very low risk of a major adverse cardiac event (MACE) over the next decade.
A score between 1 and 99 suggests mild disease, while a score from 100 to 399 signifies moderate plaque burden. These moderate scores place an individual in a higher-risk category than traditional risk factors alone might suggest. A score of 400 or greater indicates severe calcification and is associated with a significantly elevated risk of MACE. This numerical result helps your healthcare provider reclassify your total cardiovascular risk, often leading to more aggressive prevention strategies.
Essential Follow-Up Testing
A high calcium score confirms the presence of hardened plaque, but it does not reveal if that plaque is causing a blockage that restricts blood flow. The next step is to determine the functional impact of the calcification on your heart. This involves non-invasive diagnostic tests to check for significant narrowing (stenosis) and to assess for ischemia (insufficient blood flow to the heart muscle).
Your cardiologist may order a stress test, performed on a treadmill or with pharmacological agents, to monitor the heart’s function under stress and see if blood flow is compromised. If the score is very high, a Computed Tomography Angiography (CTA) might be considered. This test uses contrast dye to image the arteries and directly visualize both calcified and soft plaque, providing a detailed picture of any blockages. In cases of extremely high calcification, CT images can be difficult to interpret, and an invasive coronary angiography may be necessary to define the severity of the blockages. These follow-up tests are crucial for determining if immediate interventions are necessary.
Immediate Lifestyle Adjustments
Taking control of lifestyle factors is the most immediate and profound action you can take to stabilize existing plaque and reduce your overall risk. A heart-healthy diet is foundational, focusing on patterns like the Mediterranean or DASH diet, which are rich in fruits, vegetables, whole grains, and healthy fats. You should significantly limit saturated fats found in red and processed meats, full-fat dairy, and fried foods. Increasing your intake of sources like fish, nuts, olive oil, and high-fiber foods helps to manage cholesterol and reduce systemic inflammation.
Regular physical activity improves cardiovascular function and helps manage other risk factors like weight and blood pressure. Adults should aim for at least 150 minutes of moderate-intensity aerobic exercise, such as brisk walking, per week. Incorporating muscle-strengthening activities at least two days a week also contributes to overall metabolic health. Smoking cessation is non-negotiable, as tobacco use severely damages the arteries and accelerates plaque buildup.
Maintaining a healthy weight is important, and strategies for managing chronic stress should be integrated into your daily routine. Although these adjustments will not lower the calcification score itself, they are highly effective at stabilizing the plaque and decreasing the chance of a plaque rupture, which typically causes a heart attack.
Long-Term Medical Management
A high CAC score often necessitates the initiation or intensification of pharmacological therapy, even in the absence of symptoms. Statins are frequently prescribed because they are highly effective at lowering low-density lipoprotein cholesterol (LDL-C) and stabilizing existing atherosclerotic plaque. The goal is often aggressive, with physicians aiming for very low LDL-C targets, such as below 70 mg/dL, especially for individuals with scores above 400.
Low-dose aspirin therapy may also be recommended in select patients with a high CAC score, provided their risk of internal bleeding is low. Aspirin’s anti-clotting properties help prevent the formation of dangerous blood clots on the surface of vulnerable plaque. Beyond statins, aggressive management of co-existing conditions like hypertension and diabetes is a primary focus. Regular follow-up appointments are essential to monitor lipid panels and blood pressure, ensuring adherence to the prescribed treatment plan and long-term risk reduction.