Coronary Calcium Score: What To Know About Coronary Artery Calcium Testing

Your low-density lipoprotein, or “bad,” cholesterol is still persistently high based on the results of your blood test. However, there’s no clear high or low risk of heart disease overall for you. What happens next?

Coronary Calcium Score

You and a healthcare professional may require the results from a cardiac computed tomography (CT) scan, also known as a coronary artery calcium (CAC) test and calcium score, to choose the best course of action.

The hazards of CAC testing and whether health insurance carriers pay the expenses are discussed here, along with how calcium scores may help estimate your risk of heart disease and heart stroke.

What Is a Coronary Artery Calcium (CAC) Test?

In November 2018, the American Heart Association (AHA) and American College of Cardiology (ACC) released cholesterol treatment recommendations that incorporated the CAC test. Your risk of having a heart attack may be predicted by the screening test results.

Read More : How To Prevent a Heart Attack

Mary Norine Walsh, MD, the medical director of heart failure and cardiac transplantation at St. Vincent Heart Centre of Indiana and a past president of the American Heart Association, told Health that the scan may also assist categorize patients at intermediate risk for heart disease into high- or low-risk categories.

“That piece of information alone can’t help prevent a heart attack or stroke,” Dr. Walsh added. However, people’s responses to such findings may have an impact.

What Is Calcium Scoring?

The findings of the scan will determine your calcium score. A score of zero to more than 400 is possible. Here’s what those numbers mean:

• 0: There is no plaque and there is little chance of a heart attack.
• 1 to 10: There’s a little bit of plaque. Your risk of a heart attack is minimal, but you have a 10% chance of developing heart disease.
• 11 to 100: There’s a plaque here somewhere. You have a moderate risk of having a heart attack and mild heart disease.
• 101 to 400: There’s a fair lot of plaque. Plaque may be obstructing an artery because you have heart disease. There is a moderate to high possibility that you might have a heart attack.
• More than 400: There’s a lot of plaque here. Plaque is likely to be obstructing one of your arteries by more than 90%, increasing your risk of a heart attack.

Ron Blankstein, MD, a preventive cardiology expert at Brigham and Women’s Hospital and a past president of the Society of Cardiovascular Computed Tomography, told Health that the scale itself has no upper bound. According to Dr. Blankstein, some persons may have scores higher than 1,000.

Who Should Have a Coronary Calcium Test?

Traditional risk assessment methods that take into account blood pressure, smoking, and LDL cholesterol are not superseded by a CAC test. Nearly half of American individuals, according to the Centres for Disease Control and Prevention (CDC), have at least one of those risk factors.

However, a CAC test may assist you and your physician in determining if your risk of a heart attack is significant enough to warrant the consideration of cholesterol-lowering medication. Medications such as statins may be part of such treatment.

However, it may be a difficult decision if your risk is neither high nor low. Given that your arteries are clear as glass, why take a statin at all? In such instance, a medical professional could take a customized strategy taking your calcium scores and risk factors into account.

Why Is LDL Cholesterol Important?

140–189 mg/dL of high-density lipoprotein cholesterol is one of the major risk factors for heart disease.For those who are at a high risk of developing heart disease, an LDL cholesterol level of fewer than 70 milligrams per deciliter is ideal. The target for the remaining individuals is fewer than 100 mg/dL.

For persons without diabetes between the ages of 40 and 75, calcium scoring may be a possibility if their LDL cholesterol is 70 milligrams per deciliter or above, according to the 2018 AHA and ACC recommendations. However, their probability of having a heart attack or stroke in the following ten years is “uncertain.”

If a person’s 10-year heart disease risk is “intermediate” and their LDL cholesterol falls between 70 and 189 mg/dL, calcium scoring could also be beneficial. However, it’s unclear when therapy will begin.

According to Anthony Pearson, MD, a Saint Louis University preventive cardiology expert, “it’s definitely something we want to use when our risk is kind of in the range where maybe we want to start a statin, maybe we don’t,” as Health reported.

What Are the Benefits of CAC Testing?

Your risk of heart disease is lower than what previous tests have shown if your calcium score is zero. Therefore, if you don’t smoke, have diabetes, or have a family history of heart disease, you may be able to postpone or avoid statin medication.

As a matter of fact, a 2018 research that was published in the Journal of the American College of Cardiology examined over 13,600 individuals over the course of ten years. Those with a calcium score of zero did not show any therapeutic advantage from beginning statins, according to the study.

However, Dr. Pearson said that “you’re going to benefit a lot” from beginning a statin if you are younger than 65 and your score is higher than 100. Evidence of plaque may potentially serve as a catalyst for modifying lifestyle choices to avoid heart disease.

“For example, someone who’s smoking may be more motivated to quit,” said Dr. Walsh.

What Are the Risks of CAC Testing?

There are several risks associated with CAC testing, which include:

•   Radiation exposure: Radiation is something you have to deal with each time you have a CT scan. There is hardly much radioactivity present. However, exposure might be a problem if you need to have scans again.
• Mental health effects: For others, being categorized as high-risk might result in “psychological harm,” according to the USPSTF.
• False comfort: Even young persons with a zero score may have a significant accumulation of non-calcified plaque. People should still choose healthy lifestyles in light of this.
• Misleading results: Even if there are no indications of heart disease in your arteries, you might still have a high calcium score. The majority of false positives are found in those with minimal heart disease risk.

In addition, there’s a potential the scan may show “incidental findings,” which are additional objects that show up during the examination, such as a lung nodule. Incidental results may need further scans and treatments based on their nature.

Should I Have a CAC Test?

For young individuals aged 20 to 30, healthcare practitioners formerly believed that calcium scoring was unnecessary. That low-risk age group is rare for calcified plaque. However, a 2017 research that was published in JAMA Cardiology found that young individuals who have a nonzero CAC score of any level are at a significantly greater risk of dying from a heart attack than those in other age groups.

Adopting a heart-healthy lifestyle may help lower the risk of heart disease and heart attack for those aged 20 to 39. This includes:

• Eating a healthy diet
• Regularly exercising
• Quitting smoking
• Controlling stress
• Maintaining a healthy body weight
• Managing any health conditions, like diabetes
• Limiting alcohol
• Getting plenty of sleep

For individuals who are at high risk, a CAC test may not be appropriate. Guidelines recommend statins and other preventative measures, such lifestyle modifications, for those individuals in order to lessen the risk of heart-related problems.

CAC Testing Costs

In the event that you want to have a CAC test, the cost typically ranges from $100 to $400. However, self-pay rates vary greatly throughout the US.

Because there is a dearth of high-quality evidence demonstrating that CAC testing lowers the incidence of heart-related problems, including heart attacks, insurers in the majority of states will not cover the test as of January 2023. However, some observational data indicates that calcium scoring may be useful in identifying individuals who could benefit from prophylactic treatments.

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In the end, a lot of medical professionals that specialize in preventive cardiology use calcium scoring and CAC testing on patients, and they would want payment for this.

Thus, continue to control your heart disease risk factors until the insurance company decides to pay for the test. If you believe you might benefit from this test, speak with a healthcare professional.

Conclusion

A calcium score that may indicate your risk of heart disease is assigned to you by healthcare professionals with the use of CAC testing. Additionally, your calcium score can suggest if lifestyle modifications and statins, two preventive medications, would help lessen heart-related problems.

However, conventional testing for heart disease, such as a lipoprotein panel (lipid panel) that evaluates cholesterol, is not replaced by CAC testing. In general, find out from your healthcare practitioner which tests are appropriate for you and your risk of heart disease.