When it comes to knowing your heart
health, there's a whole lot more than cholesterol and blood pressure to
monitor. One not-so-well-known but increasingly crucial metric is the coronary
artery calcium (CAC) score. On initial glance, it may seem like another
complicated medical term, but it can actually teach you a great deal about your
likelihood of heart attack.
But here's the surprise: more recent
studies are refuting past assumptions. While doctors previously considered
elevated calcium to be a warning sign, others now interpret it as evidence of
stability. So, what exactly is the coronary calcium score, and should you be
concerned if yours is elevated?
What Is a Coronary CalciumScore?
A coronary calcium score is a test result
that is measured with a non-invasive CT scan to look for deposits of calcium in
your coronary arteries, the tubes that bring blood to your heart muscle.
These calcium deposits are an indication
of atherosclerosis, a hardening and narrowing of the arteries caused by plaque
deposition. The plaque is made up of fat, cholesterol, calcium, and other
substances found in the blood. The presence of calcium in the arteries often
indicates that there is some plaque that has already been present for a period
of time.
The scan gives a score from 0 to a couple
or a few hundred or more:
●
0 means there is no
detectable calcium
●
1-99 means there is mild
accumulation
●
100 to 399 means there
is moderate
●
400 and above means
there are substantial amounts of calcium deposits
In the past, if you received a higher
score, it probably meant you were at higher risk of having a heart attack, but
that's not necessarily the case anymore.
The Traditional View: Calcium
= Danger
For decades, cardiologists relied on the
calcium score as a predictor for cardiac events. The higher your score, the
more plaque, and the more plaque, the greater the probability of a heart attack
in the next ten years.
Actually, in a big study known as the
Multi-Ethnic Study of Atherosclerosis (MESA), people with a calcium score above 300 had between 6 to 9 times the risk of a heart event than those who scored zero.
This made the test a first-choice
screening test, particularly for individuals who had risk factors such as
diabetes, high blood pressure, or a history of heart disease in the family but
weren't yet experiencing symptoms.
A Newer Perspective: Could
Calcium Be Protective?
Later studies, however, suggest a more
subtle picture. The existence of calcified plaque can actually be safer than
that of soft, non-calcified plaque. Why? Soft plaques are more likely to burst,
which is what usually leads to a heart attack.
Conversely, calcium deposits set the
plaque solid, so it's less likely to rupture. Think of it like constructing a
firm wall—once hardened, it won't fall down.
Certain pioneering studies have even
discovered that people with greater physical activity levels, like endurance
runners, tend to have higher coronary calcium scores but lower actual risk of
heart attack.
One particularly interesting study noted
that very active individuals had more elevated CAC scores but concurrently lower cardiovascular mortality rates than inactive people with lower scores.
So Why Are Some High Scores
Still Risky?
Although this new perspective sounds
comforting, it does not always mean that a high calcium score is safe. Context
is key, very much so.
For instance:
●
A sedentary diabetic
individual who scores 500 might be in greater danger than an extremely active
athlete who scores the same.
●
A patient who
experiences mild chest pain with exercise could have high calcium deposits on
an angiogram, but that can be due to decades of established plaque development,
not necessarily an emergent block.
In other words, the number alone doesn’t
tell the full story. Other risk factors, such as cholesterol, blood sugar
levels, lifestyle habits, and family history, must be taken into account.
What About Patients With Low
or Zero Calcium Scores?
You may think that a zero score indicates
you're totally in the clear, but that isn't always so either.
Fortunately, it so happens that individuals who have suffered heart attacks had
minimal or no coronary calcium after the episode. This is due to the fact that
soft plaques, which are not detectable on a calcium scan, may still rupture and
suddenly become totally blocked.
This happens more often in younger adults, people with diabetes, or those who
have inflammatory conditions that cause plaques to become vulnerable.
So, a zero score might be reassuring, but it's no guarantee.
The Misconceptions Around CoronaryCalcium
The changing research shows a fundamental
flaw in how we're reading coronary calcium scores. Here are a few widespread
misconceptions worth dispelling:
Misconception
1: "High calcium means you're going to have a heart attack."
Reality: High calcium actually signifies
stable plaque, which might actually decrease the likelihood of rupture.
Misconception
2: "Zero calcium score means you're perfectly safe."
Reality: You may still have soft,
non-calcified plaque that is invisible on a CAC scan.
Misconception
3: "Removing calcium from arteries is the best approach."
Truth: Certain alternative therapies,
such as chelation, that promise to "clean out" arteries are not
proven scientifically to ward off heart attacks. More critical is addressing
risk factors in an overall way.
So, Should You Be Concerned?
If your calcium score is high, don't
freak out but don't dismiss it either.
Rather, have a discussion with your
cardiologist beyond the number. Your doctor will consider
● Your total risk profile
● Symptoms, if any
● Other test results
● Activity and lifestyle
You might not require such emergency
procedures as stents or bypass. Your doctor might instead suggest
● Lifestyle changes (diet, physical activity, no smoking)
● Statins to stabilize plaques already present
● Regular monitoring and follow-up
Understanding the Bigger
Picture
Calcium scoring is a helpful tool, but
it's only one piece of the heart-health puzzle. Reading the score
independently, to the exclusion of your general health, lifestyle, and medical
history, can be misleading.
It's also worth noting that calcium
density is significant. More dense calcium can signal more stable plaques,
whereas mixed-density or scattered plaque can be more concerning.
New diagnostic techniques and imaging technologies are now opening the door to being able to distinguish between unstable and dangerous plaque more clearly, which may influence more tailored treatment strategies in the future.
InterpretingYour Score the Right Way
Understanding
your coronary calcium score is just the beginning. It’s how you act on that
knowledge, through lifestyle changes, clinical advice, and proactive heart
care, that makes the difference.
For those seeking a non-invasive and holistic approach to managing heart health, Heal Your Heart Clinic offers expert consultations and advanced therapies designed to support your cardiovascular journey with care and clarity.
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