Dr Shawn M. Carney
Coronary Artery Calcium Scoring (Heart Scan) - the imaging test that might save your life for $99!
"It is gaining popularity because of its high accuracy in predicting atherosclerotic cardiovascular disease risk in asymptomatic individuals with low to moderate atherosclerotic cardiovascular disease risk". (1)
Coronary Heart Disease (CHD), which is the most common type of heart disease in the United States, (2) is also known as 'Coronary Artery Disease' (CAD), 'Ischemic Heart Disease', or 'Coronary Atherosclerosis'. When people talk about 'heart disease' they often mean CHD. As the leading cause of death for men and women in the United States, about 697,000 died from it in 2020 - which is 1 in every 5 deaths. (3) With CHD being such a significant health risk, it is prudent to consider methods of detection that are effective and practical.
What is Coronary Artery Calcium Scoring?
This painless, noninvasive, diagnostic imaging technique will provide images of blood vessels to the heart. Plaque — made of fatty compounds, cholesterol, calcium and other substances — can build up and narrow or close the arteries. To detect this build-up, clinicians may order 'coronary artery calcium (CAC) scoring' — a test that is also known as 'cardiac calcium scoring', 'coronary calcium scan', a 'heart scan' or simply, 'calcium score'. This test uses computer tomography (CT) scans, which create highly detailed, cross-sectional images, or slices, of internal organs and blood vessels. CAC scoring can thus be thought of as a targeted CT scan, or specialized X-ray test, that provides pictures of your heart, thereby allowing for the measurement and detection of calcium-containing plaque in the arteries.
As X-ray technology, CAC scoring does expose a person to radiation, but the payoff and insight gained can be well worth it, especially for asymptomatic people! I mean, we are talking about an inexpensive and accurate procedure that should take about 10 to 15 minutes, for goodness sakes.
"Coronary calcium is exclusively the outcome of coronary atherosclerosis, with the exception of individuals with renal insufficiency, ... . The quantity of calcium in the vessels is generally proportional to the amount of atheroma in the coronary vessels. The CAC score ... can assist in cardiovascular risk assessment and, as a result, clinical decision-making. According to the European Guidelines on heart disease prevention in clinical practice, the CAC score can be used to predict heart disease risk in asymptomatic adults at intermediate risk." (1)
"In fact, individuals with no risk factors and an elevated CAC score have nearly three times the event
rate of those individuals with multiple risk factors and a CAC score of zero." (4)
About Coronary Artery Calcium Scoring
CAC scoring is calculated based on the amount of plaque observed in the CT scan. The amount of calcium is quantified by multiplying each area of calcified plaque with its corresponding CT density. A CAC score is generally converted to a percentile rank based on age and gender. One's likelihood of having heart disease or a heart attack correlates with their CAC scoring. The lower your calcium score and percentile rank, the less likely you are to have a cardiac event compared to other men or women your age.
What do the results mean?
Zero: No plaque. Risk of heart attack is very low, way to go!
1 - 10: Small amount of plaque. Minimal atherosclerosis may be present with a low risk of future cardiovascular events, perhaps less than a 10% chance.
11-100: Some plaque. There is likely mild to minimum coronary artery stiffening and stenosis. A mild risk of CAD exists.
101 - 400: Moderate amount of plaque. Heart disease is present and a plaque may be blocking an artery. The chance of having a heart attack is moderate to high. Healthcare professionals may want more tests and to start a person on treatment.
Over 400: Large amount of plaque. There is more than a 90% chance that plaque is blocking an artery. A person's chance of heart attack is high and consultation with a healthcare professional would be prudent so as to start treatment.
Global Guidelines for Coronary Artery Calcium Scoring
A review was published just earlier this year comparing the guidelines of different cardiovascular societies worldwide. (5) That synthesis included 1) the 2019 American College of Cardiology/American Heart Association Guideline on the Primary Prevention of Cardiovascular Disease; 2) the 2021 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for Prevention of Adult Cardiovascular Disease; 3) the 2019 European Society for Cardiology/European Atherosclerosis Society Guidelines for the Management of Dyslipidemias; 4) the 2016 National Institute for Health and Care Excellence Clinical Guidelines; 5) the Cardiac Society of Australia and New Zealand Guidelines on CAC; 6) the Chinese Society of Cardiology Guidelines; 7) the Japanese Atherosclerosis Society Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases; and 8) statements made by specialty societies including the National Lipid Association, Society of Cardiovascular Computed Tomography, and U.S. Preventive Services Task Force.
They found common indications for CAC scoring were:
AGE GREATER THAN 40 years old
RISK determined as INTERMEDIATE
SYMPTOMS as highly beneficial for ASYMPTOMATIC PERSONS
They also found that common treatment thresholds began with a CAC score GREATER THAN 100.
Healthcare providers may further recommend a CAC Scoring if someone has risk factors for CHD/CAD including:
Family history of heart attacks
High blood pressure
It is important to note that the result of CAC scoring shouldn't be used as a single predictor of overall health and risk of heart disease. The information from CAC scoring should be combined with other health information.
And as mentioned above, the cost for this non-invasive procedure often ranges as low as $99! So if you or someone you know is faced with these risk factors or concerns, valuable insight may be just a quick scan away.
Visit our newly published, heart health landing page:
Cardiovascular Disease (CVD) and High Blood Pressure
for information on types of CVD, risk factors for CVD, the role of integrative medicine in heart health, laboratory values, natural therapies, and more!
1. Shreya, Devarashetty et al. “Coronary Artery Calcium Score - A Reliable Indicator of Coronary Artery Disease?.” Cureus vol. 13,12 e20149. 3 Dec. 2021, doi:10.7759/cureus.20149.
2. Center for Disease Control and Prevention. Coronary Artery Disease (CAD).
https://www.cdc.gov/heartdisease/coronary_ad.htm. Accessed 12-14-22.
3. Center for Disease Control and Prevention. Heart Disease Facts.
https://www.cdc.gov/heartdisease/facts.htm. Accessed 12-14-22.
4. Divakaran, S et al. “Use of cardiac CT and calcium scoring for detecting coronary plaque:
implications on prognosis and patient management.” The British journal of radiology vol. 88,1046
(2015): 20140594. doi:10.1259/bjr.20140594.
5. Golub, Ilana S et al. “Major Global Coronary Artery Calcium Guidelines.” JACC. Cardiovascular
imaging vol. 16,1 (2023): 98-117. doi:10.1016/j.jcmg.2022.06.018.
6. **image credits Shreya, Devarashetty et al. “Coronary Artery Calcium Score - A Reliable Indicator
of Coronary Artery Disease?.” Cureus vol. 13,12 e20149. 3 Dec. 2021, doi:10.7759/cureus.20149.
The content and any recommendations in this article are for informational purposes only. They are not intended to replace the advice of the reader's own licensed healthcare professional or physician and are not intended to be taken as direct diagnostic or treatment directives. Any treatments described in this article may have known and unknown side effects and/or health hazards. Each reader is solely responsible for his or her own healthcare choices and decisions. The author advises the reader to discuss these ideas with a licensed naturopathic physician.