A Coronary Artery Calcium (CAC) score is a direct measurement of the calcified plaque burden in the coronary arteries, obtained through a non-invasive computed tomography (CT) scan. It serves as a powerful diagnostic tool for cardiovascular risk assessment, providing a “snapshot” of existing atherosclerosis, or hardening of the arteries. A high CAC score indicates a significant buildup of calcified plaque, which independently predicts a heightened risk for future cardiac events like a heart attack or stroke. Receiving a high score signals that immediate, aggressive intervention is necessary to stabilize the disease and reduce the chance of a life-threatening event.
Interpreting Your Coronary Artery Calcium Score
The CAC score is quantified using the Agatston score method, which calculates the extent of calcification based on the area and density of detected calcium deposits. The resulting numerical score directly correlates with the severity of coronary artery disease and the likelihood of a major cardiac event. A score of zero suggests a very low risk of a heart attack over the next decade, though it does not rule out the presence of “soft,” non-calcified plaque.
Scores are stratified into ranges to guide risk assessment and treatment decisions. A score between 1 and 100 indicates mild plaque burden, while 101 to 400 is considered moderate, associated with a moderately increased risk of a cardiac event. A score exceeding 400 signals a high to severe plaque burden, placing the individual in a high-risk category for a future coronary event. This high score is a powerful predictor of risk, prompting a significant shift toward intensive preventive treatment.
The CAC score is particularly valuable because it represents the existing disease burden, offering information independent of traditional risk factors like cholesterol or blood pressure. This measure helps healthcare providers confirm the presence of disease rather than just predicting risk. For those with high scores, the risk of an incident atherosclerotic cardiovascular disease (ASCVD) event, such as a heart attack, is substantially increased compared to individuals with a score of zero.
Pharmacological Treatment Strategies
A high CAC score triggers the immediate implementation of aggressive pharmacological therapy designed to halt plaque progression and stabilize existing lesions. High-intensity statins are the primary medication class prescribed, often regardless of the patient’s baseline low-density lipoprotein (LDL) cholesterol level. These medications work by lowering circulating cholesterol, reducing the inflammatory process driving plaque formation, and stabilizing existing plaque to prevent rupture.
The goal of this intensive lipid-lowering therapy is to achieve a very low LDL-C target, often below 70 mg/dL, or even lower for those with very high scores. If high-intensity statin therapy alone is insufficient, non-statin therapies like ezetimibe or PCSK9 inhibitors may be added to further reduce cholesterol. This aggressive approach acknowledges the high-risk status conferred by the confirmed presence of calcified plaque.
For patients with a high CAC score, particularly those over 100, low-dose aspirin therapy is often considered, provided the risk of a major bleeding event is low. Aspirin works as an antiplatelet agent, reducing the likelihood of a blood clot forming on a ruptured plaque, which causes most heart attacks. Aggressive management of co-existing conditions is also undertaken. Hypertension is treated with agents like ACE inhibitors or ARBs, and diabetes requires strict glucose control, often utilizing newer agents like SGLT2 inhibitors or GLP1-RAs, which have shown cardiovascular benefits.
Critical Lifestyle Modifications
Pharmacological treatment must be paired with immediate and sustained lifestyle changes, which are the foundation for long-term risk reduction. Dietary modifications should center on a heart-healthy pattern, such as the Mediterranean or Dietary Approaches to Stop Hypertension (DASH) diet. This involves:
- Increasing the consumption of fruits, vegetables, whole grains, and healthy fats (like olive oil and nuts).
- Limiting saturated and trans fats.
- Limiting refined carbohydrates.
- Limiting sodium.
Quitting smoking is the single most impactful action a person with a high CAC score can take, as tobacco use drastically accelerates atherosclerosis and increases the risk of plaque rupture. Cessation provides an immediate and substantial reduction in cardiovascular risk that no other intervention can replicate. This change is non-negotiable for anyone diagnosed with confirmed coronary artery disease.
Regular physical activity is necessary, with a standard recommendation of at least 150 minutes of moderate-intensity aerobic exercise per week. Aerobic activities, like brisk walking or swimming, help improve endothelial function, lower blood pressure, and contribute to weight management. While exercise may not lower the existing calcium score, it significantly reduces the overall cardiovascular event risk by improving heart function and managing other risk factors. Weight management, aimed at achieving a healthy body mass index, and chronic stress reduction further contribute to lowering the inflammatory burden on the arteries.
Ongoing Assessment and Management
Long-term management following a high CAC score diagnosis involves continuous monitoring and regular communication with a cardiologist to ensure treatment goals are met. Patients should expect periodic blood work, including a full lipid panel, a check of blood glucose control via HbA1c, and sometimes inflammatory markers like high-sensitivity C-reactive protein (hsCRP). These tests confirm that prescribed medications and lifestyle changes are successfully modifying the underlying risk factors.
Regular follow-up appointments allow the healthcare team to adjust medication dosages and reinforce lifestyle adherence based on lab results and the patient’s overall health status. While the initial CAC score provides risk stratification, the test is generally not repeated in the short term. Calcium accumulation is a slow process, and the focus remains on controlling risk factors for future events. The primary goal is to stabilize the plaque and prevent cardiac events.
If a patient develops new symptoms suggestive of restricted blood flow, such as chest pain or shortness of breath, the management plan will escalate to advanced non-invasive testing. This may involve a stress test to assess for blockages that limit blood flow during exertion, or a CT angiography to visualize the coronary arteries. This proactive management strategy is designed to ensure early detection of any high-grade blockages and to provide a clear, long-term path for living a heart-healthy life.