Coronary Artery Health with CT Coronary Artery Calcium Score

What is it: The CT Coronary Artery Calcium scan (CACS) is a low dose CT scan procedure that allows us to know whether the arteries of your heart have atherosclerosis (see section on Heart in Health and Disease). As atherosclerosis progresses, calcium is deposited in the plaque. The calcium deposits are very easy to see with a low dose CT scan. The greater the amount of calcium in the coronary arteries, the greater the risk of heart events. The degree of calcium deposits are measured using a computer to calculate the Agatston Score developed by Dr. Arthur Agatston who developed the scoring system in 1991. You may know him for his popular book, “The South Beach Diet”.
The CACS does not detect the soft cholesterol rich plaque that precedes formation of calcium. Fortunately, with a CAC score of zero, even if there is some soft plaque that was not seen, the risk of heart problems over next 5-8 years is low. A CAC score of zero should be interpreted in the context of specific risk factors and results should always be discussed with your doctor.

Who may benefit from a Coronary Artery Calcium Scan: Current guidelines recommend formal assessment of the risk of atherosclerosis starting at age 40. Risk calculators (https://tools.acc.org/ascvd-risk-estimator-plus/) are used to estimate 10-year risk. If after risk assessment there is uncertainty about starting cholesterol lowering medications like statins, a CT calcium artery calcium score may provide additional information to guide the need for and intensity of treatment efforts. People at high risk (>20% 10-year risk) and at low risk (<5% 10-year risk) do not benefit from coronary artery calcium scoring.

How the test is done: There is no preparation for this simple CT scan. The technologist will position you on the scanner table and attach small adhesive electrodes to your skin to monitor your heart rhythm. The technologist will go to the control room and run the test while watching you through a glass window and talking with you using an intercom. You will be asked to lay still and hold your breath for a few seconds and a brief x-ray dose will be delivered. That is it. Test over. The cardiologist will do an interpretation and create a report that gives you an Agatston score. The report will give a total score and a score for each artery of the heart’s blood supply.

What the Results Mean:

CAC=0 indicates low risk. Live a healthy lifestyle. Most people do not need statins.
CAC=1-99 indicates mildly increased risk. Besides lifestyle modification, preventive cardiologists recommend moderate intensity statin.
CAC 100-299 indicates moderately increased risk. Besides lifestyle modification, preventive cardiologists recommend moderate intensity statin and consider low dose aspirin (81 mg).
CAC>300 indicates high risk. Besides lifestyle modification, preventive cardiologists recommend, high intensity statin and low dose aspirin.

What do I do with the results?
My Heart Vision strongly recommends that you discuss your specific results, even if normal, with your physician who knows you best. If you do not have a physician, ask us for a recommendation.

Bottom Line: At the current time a low dose CT Coronary Artery Calcium Score is simply the easiest and best way for people without symptoms or prior heart problems to know if they have plaque (atherosclerosis) in the arteries of their hearts, and how severe it is. At My Heart Vision we say: “To See Is To Know”™. Knowledge of disease presence and severity allows more personalized decisions for treatment.

For more reading on this important topic, here is a great summary published in January 2023 ‘Major Global Coronary Artery Calcium Guidelines. (J Am Coll Cardiol Img. 2023 Jan, 16 (1) 98–117).