A Coronary Artery Calcium (CAC) score is a measurement derived from a specialized, non-contrast computed tomography (CT) scan of the heart. This score quantifies the amount of calcified, or hardened, plaque present in the walls of your coronary arteries. These calcium deposits are a direct marker of atherosclerosis, the underlying disease process that leads to heart attacks and strokes. A high CAC score indicates established coronary artery disease, raising the risk for a major cardiovascular event. Understanding this result requires consultation with a physician to develop a personalized action plan.
Interpreting the Calcium Score Results
The CAC score is calculated using the Agatston method, which translates the area and density of the detected calcium into a single numerical value. This number directly corresponds to the extent of atherosclerosis within your coronary arteries. The score provides a more accurate picture of individual risk compared to traditional risk factor calculators alone.
A score of zero is considered very low risk, suggesting the absence of detectable calcified plaque. A score between 1 and 100 indicates a mild to moderate amount of calcification, which is typically considered a moderate risk compared to your peers. Once the score surpasses 100, the risk increases substantially, signaling a need for intensified preventive action.
A score ranging from 101 to 400 is generally categorized as moderate to high risk, where the presence of disease is confirmed and the risk of a future event is elevated. A score greater than 400, or a score in the 75th percentile or higher for your age and sex, places you in the high-risk category, indicating established and extensive coronary artery disease. This necessitates a shift toward aggressive medical and lifestyle management. The calcium itself is a stable component of the plaque, but its presence is a powerful predictor of future unstable events.
Essential Medical Management
A high CAC score requires a treatment strategy focused on stabilizing and preventing the progression of existing plaque. This approach is typically led by a cardiologist or primary care physician. A cornerstone of this medical strategy is the initiation of high-intensity statin therapy, regardless of baseline LDL cholesterol level.
Statins, which are HMG-CoA reductase inhibitors, work to lower low-density lipoprotein (LDL) cholesterol, but more importantly, they help stabilize existing plaque and reduce inflammation within the artery walls. A high-intensity statin regimen is recommended because it has been shown to slow the progression of atherosclerosis. Even if your score increases slightly while on statins, this can paradoxically indicate that the plaque is becoming denser and more stable, a process known as plaque calcification.
Aggressive control of blood pressure is another priority, with target goals often set below 130/80 mmHg for most individuals with established heart disease. Medications such as Angiotensin-Converting Enzyme (ACE) inhibitors or Angiotensin II Receptor Blockers (ARBs) may be prescribed to achieve these targets while offering additional protective effects on the blood vessel lining. Low-dose aspirin or other antiplatelet agents may be recommended, but this decision is highly individualized based on your risk of bleeding versus the benefit of preventing a blood clot.
Your physician may recommend additional diagnostic testing, such as a stress test or a Coronary CT Angiography (CTA), especially if you experience symptoms like chest pain or shortness of breath. These tests help determine if the plaque is causing a flow-limiting blockage that might require intervention.
Immediate and Long-Term Lifestyle Modifications
Medical management works best when paired with sustained changes to daily habits. Dietary changes should focus on heart-healthy eating patterns like the Mediterranean or Dietary Approaches to Stop Hypertension (DASH) diets. These plans emphasize a high intake of vegetables, fruits, whole grains, and lean proteins.
Physical activity is another powerful tool, and a goal of at least 150 minutes of moderate-intensity aerobic exercise each week is widely recommended. Moderate intensity includes activities like brisk walking, cycling, or swimming that noticeably elevate your heart rate. Regular exercise helps manage weight, improve blood pressure, and positively influence cholesterol levels.
Smoking cessation is necessary, as tobacco use rapidly accelerates arterial damage. Existing chronic conditions, particularly diabetes, must be managed meticulously, as high blood sugar contributes to vascular disease.
Incorporating stress management techniques and prioritizing sleep contributes to overall heart health. Consistent, long-term adherence to these modifications is necessary to complement the medical strategy and stabilize coronary artery disease.