Coronary Artery Calcium Scoring: what it is and how it can protect your heart
Coronary artery calcium scoring is a simple, non-invasive test that can help detect coronary artery disease (CAD). It uses a low-dose CT scan to check for calcium deposits in the arteries of your heart. Calcium in the arteries is easily visible with a 3D x-ray or CT scan, similar to how bones appear on x-rays. This test can provide valuable insights into your heart health and guide your risk management for heart attacks.
How the Test Works
The process is straightforward and quick. No preparation is required — no need for IVs, gowns, or fasting. You’ll lie on a scanner table, hold your breath for a few seconds, and the scan is done. The radiation dose is low, similar to that of a mammogram, and no contrast dye is used.
Why Is Calcium Scoring Useful?
Unlike population-based risk assessments (such as the Framingham risk score), a calcium score offers a personalized look at your heart health. It can be a wake-up call for some patients, prompting them to adopt healthier habits or consider medications like aspirin or cholesterol-lowering therapies.
Cost and Insurance Considerations
One thing to keep in mind: most health insurance plans don’t cover coronary artery calcium scoring. The out-of-pocket cost is typically around $200.
Important Limitations of Calcium Scoring
While calcium scoring is a helpful tool, it has its limits:
1. Not Trackable Over Time
Calcium scores can’t be used to monitor changes in plaque. In fact, many patients who have heart attacks had a calcium score of zero just a few years prior. This is because the test only detects calcified (hardened) plaque, which is stable and less likely to cause heart attacks. The more dangerous soft, lipid-rich plaque (responsible for heart attack) doesn’t show up. A coronary CT angiogram, which uses an IV and costs more, is needed to detect this type of plaque.
2. Calcium Scores Can Increase With Treatment
Effective lifestyle changes and treatments (like controlling cholesterol, blood pressure, and blood sugar) can actually increase your calcium score. This is because these measures convert dangerous, soft plaque into more stable, calcified plaque. So, once you have a positive calcium score, there’s typically no need to repeat the test. A higher score doesn’t necessarily mean your condition is worsening. Instead, a CT coronary angiogram can help track all plaque types over time.
When Should You Consider Calcium Scoring?
If you have a family history of early heart disease or other risk factors (such as high cholesterol or high blood pressure) but are hesitant to take preventative measures, calcium scoring may be a good option. It provides a clearer understanding of your heart disease risk and may encourage lifestyle changes or medication use.
How to Interpret Your Score
Here’s a general guide for understanding calcium scores:
Score of 0: Somewhat reassuring.
Score < 100: Enough to take preventative measures.
Score 100 - 400: A significant concern that warrants medical attention.
Score > 400: Very concerning and may indicate the need for further testing.
Take Charge of Your Heart Health
Coronary artery calcium scoring is a useful tool to help you understand your heart disease risk. While it has limitations, it can guide decisions about lifestyle changes and medical treatments. If you think calcium scoring could benefit you, speak with your cardiologist to determine your best course of action.
