A Coronary Artery Calcium Score (CACS) is a non-invasive tool that measures the amount of calcified plaque within the walls of your heart’s arteries. This calcium is a direct indicator of atherosclerosis, a disease where fatty deposits build up and harden the arteries over time. The result, known as the Agatston score, provides an assessment of your future risk for a heart attack or other cardiovascular events. Receiving a high score signifies that the atherosclerotic process is underway and necessitates proactive medical attention.
Understanding Your High Score
The CACS is quantified using the Agatston scoring method, which considers both the area and density of the detected calcium deposits. A score of zero means no calcified plaque was detected, suggesting a very low risk of a heart attack in the short term. The higher your score, the greater the total plaque burden in your coronary arteries, and the higher your long-term cardiovascular risk.
Scores between 1 and 99 indicate mildly increased risk, while a score from 100 to 399 indicates a moderate plaque burden. A score over 400 is associated with a severe amount of calcified plaque, placing you in a high-risk category for future cardiac events. The score measures the presence of calcified plaque, which is a sign of past damage, and does not directly measure a current blockage that would cause symptoms like chest pain.
The score effectively reclassifies your overall risk, often moving you to a high-risk category, even if you have no symptoms. This shift changes the threshold for aggressive preventative medical interventions. The presence of calcium signals a substantial amount of coronary artery disease, which raises the likelihood of future problems.
Consulting Your Healthcare Provider and Further Assessment
The most important next step after receiving a high CACS is to schedule a consultation with your primary care physician or a cardiologist. This appointment integrates your CACS result with your personal health history and traditional risk factors, such as blood pressure and family history. You should bring the full CT scan report, as the physician will want to review the specific distribution of the calcification.
The physician will likely order additional diagnostic tests to establish a complete risk profile and determine the best course of action. A comprehensive lipid panel is standard, measuring cholesterol levels, including low-density lipoprotein (LDL-C) and triglycerides. They may also check your blood sugar control through a blood glucose or A1C test, as diabetes accelerates atherosclerosis.
If you are experiencing symptoms like shortness of breath or chest discomfort, or if your score is particularly high (e.g., above 400 or 1000), your provider may recommend functional testing. This often includes a stress echocardiogram or a nuclear stress test, which evaluate how well blood flows to your heart muscle during physical exertion. These tests help determine if the existing plaque is causing functional limitations in blood flow.
Medical Management and Treatment Options
A high CACS mandates the initiation of preventative pharmacological therapy. Primary medical management involves Statin therapy (HMG-CoA reductase inhibitors). These medications lower LDL-C levels, which is necessary for stabilizing existing plaque and slowing the progression of atherosclerosis.
Guidelines recommend aggressive statin use for individuals with CACS results above 300, often regardless of initial cholesterol levels. The goal of this treatment is to stabilize plaque and leverage the anti-inflammatory effects of statins. For many high-risk patients, the target LDL-C level is set very low, sometimes below 70 mg/dL, requiring high-potency statins.
Your physician will also manage other modifiable risk factors with medication. Blood pressure medications, such as ACE inhibitors or calcium channel blockers, may be prescribed to ensure blood pressure is well controlled, reducing strain on arterial walls. Low-dose aspirin may be considered to reduce the risk of blood clots forming on vulnerable plaque, though this decision is highly individualized and weighed against the risk of bleeding.
Necessary Lifestyle Modifications
While medications are important, long-term cardiovascular health relies on changes to daily habits. Dietary modification is a primary focus, emphasizing patterns like the Mediterranean or DASH (Dietary Approaches to Stop Hypertension) diets. This involves:
- Increasing consumption of vegetables, fruits, and whole grains.
- Incorporating healthy fats like olive oil and omega-3 fatty acids.
- Sharply limiting saturated and trans fats.
- Reducing consumption of processed and red meats.
Regular physical activity is essential for improving heart health and managing cardiovascular risk factors. The general recommendation is to aim for at least 150 minutes of moderate-intensity aerobic exercise, such as brisk walking or swimming, each week. Incorporating muscle-strengthening activities, like resistance training, on at least two days a week aids in managing weight, blood pressure, and blood sugar levels.
For individuals who smoke, immediate and complete cessation is crucial to slow the progression of coronary artery disease. Smoking damages the lining of the blood vessels and accelerates plaque buildup, so quitting offers protective benefits. Implementing stress management techniques, such as mindfulness or yoga, helps mitigate the chronic inflammatory effects that persistent mental stress can have on the cardiovascular system.