What is a coronary artery calcium score?

The test is a non contrast enhanced CT of the chest.

It is a robust predictor of coronary events in asymptomatic individuals.

The goal is to measure the amount of calcium in the coronary arteries, which reflects the presence of plaque, which generally corresponds to the presence of atherosclerotic disease. The presence of non calcified place is unusual in asymptomatic individuals with ischemic disease.

A score is give to the amount of calcium in the coronary arteries:

1 to 10 minimal plaque

11 to 100 mild plaque

101 to 400 moderate plaque

greater than 400 severe plaque

The score gives us insight into risk of a MI, stroke or congestive heart failure in asymptomatic individuals.

The test is associated with radiation exposure, equivalent to or less than a mammogram.

The test can be used in addition to the Framingham Risk Calculator and c-reactive protein in order to help predict the risk of a cardiac event.

The test remain controversial and may not be reimbursed by insurance companies.

Despite well established guidelines for cancer screening for cancers such as breast, colon and prostate; well established guidelines for cardiac disease screening other than blood pressure and cholesterol checks,  are not well established. Use of cardiac assessment modalities have been largely based on personal risk factors along with personal and family health history. Cardiac disease is the leading cause of death, greater than all cancers combined, in both men and women.

Who should have this test?

This test may be used to enhance adherence to lifestyle or medical recommendations.

It may used to determine risk of cardiac events in asymptomatic,intermediate risk individuals.

The test is used in a personalized fashion to assess an individuals risk for cardiac disease.

Risk factors for coronary artery disease include:

  • high blood cholesterol levels
  • family history of heart attacks
  • diabetes
  • high blood pressure
  • cigarette smoking
  • overweight or obese
  • physical inactivity

What do I do if I have an abnormal score?

Review the test with your personal physician.

Additional imaging and evaluation may be recommended. Stress testing may be reviewed, as well as myocardial perfusion imaging. 

Interventions such as nutrition, lifestyle, statins and aspirin may be recommended.

Additional imaging may be recommended to determine effects of interventions.. 

Repeat scan recommendations:

For asymptomatic individuals and score of 0 - repeat scan at 4 years is recommended. There have been no guidelines for others.