Is Coronary Calcium Scoring Right for You? 4 Things to Know

December 13, 2023

Illustration of cholesterol plaque in clogged artery

While most people rely on their blood pressure or cholesterol numbers to manage their heart health, another test may be even better. Coronary calcium scoring is a simple imaging test that measures your future risk of heart attack and stroke.

“Data from the last 20 years shows that calcium scoring is better than the standard risk markers for heart disease, such as cholesterol and blood pressure,” says Ian Neeland, MD, Director of Cardiovascular Prevention at University Hospitals Harrington Heart & Vascular Institute. “The calcium score more accurately defines a person’s risk for heart attack and stroke and dying from heart disease over the next 10 years.”

What Calcium Scoring Measures

A calcium score is based on a low-dose radiation CT scan of your coronary arteries, and it gives doctors important information that helps guide medication decisions and other preventive treatment.

The imaging test, which takes 10 to 15 minutes, measures the amount of calcified plaque in the coronary arterial walls. The accumulation of coronary plaque is known as atherosclerosis, or hardening of the arteries. It leads to heart disease, blocked arteries, heart attack, stroke and angina.

A calcium score under 100 is considered low risk. A score of 400 or more is considered high risk.

Understanding Heart Disease Risk

Most people know that high blood pressure, cholesterol, blood sugar and cigarette smoking are risk factors for heart disease. But other factors also increase the risk:

Family history of heart disease at age 55 or younger in men and 65 or younger in women.
Chronic kidney disease.
Conditions in women such as preeclampsia or early menopause.
Chronic inflammatory conditions such as inflammatory bowel disease, lupus, psoriasis, rheumatoid arthritis and HIV/AIDS.

The role of inflammation in heart disease has come into greater focus in recent years. It’s not only chronic inflammatory diseases that are a concern. Poor diet, smoking, stress and excess belly fat can also trigger systemic inflammation.

Inflammation can spur the growth of plaque in the arteries and also raise the risk of plaque breaking loose and forming blood clots that cause heart attacks and strokes.

“Chronic inflammation makes atherosclerosis worse,” Dr Neeland says. “When fatty plaque develops in the walls of the arteries, it gets inflamed. The body sees it as foreign and wants to attack it. This stimulates an immune response, which builds up additional calcium and plaque in walls of the artery. That plaque can rupture. When it ruptures, that causes heart attack or stroke.”

A blood test for C-reactive protein can measure inflammation in the body, providing additional information about risk and guiding preventive treatments.

Who Benefits from Coronary Calcium Scoring

Coronary calcium scoring isn’t for people with known heart disease. These patients should already be utilizing cholesterol-lowering drugs and other measures to prevent heart attack and stroke.

The test is designed for people over age 45 at intermediate risk of disease, with one or more risk factors (mentioned above).

Acting On the Results

For many patients, their calcium score will guide decisions about cholesterol medications.

“It can help guide statin treatment or low-dose aspirin treatment as primary prevention,” Dr. Neeland says. “It can determine how aggressive you want to be with cholesterol management, weight management and with further testing for coronary artery diseases, such as a stress test.”

A cardiologist or your primary care doctor can order a coronary calcium score test for you.

Watch a video about coronary calcium testing.