Coronary Calcium Score: What Is It and Should You Be Concerned?

 

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.