What is a CT Coronary Artery Calcium Heart Scan?
The coronary artery calcium heart scan is a CT scan of the heart that looks for areas of calcium in the arteries that supply the heart with blood. The amount of calcium detected is then added together to give a score. The more calcium there is, the higher the score. Calcium signifies calcified plaque in the heart arteries. Plaque is the substance that leads to blockages and when it bursts, known as plaque rupture, it is what leads to a heart attack. The point of the CT coronary artery calcium heart scan is to determine the cardiovascular risk of a person. The score is typically obtained in people who are otherwise healthy and don’t have symptoms to try and assess their risk.
What Do The CT Coronary Artery Calcium Scores Mean?
A calcium score of 0 means there is no calcified plaque in the arteries
A calcium score of 1-10 means minimal plaque
A calcium score of 11-100 means mild plaque
A calcium score of 101-400 means moderate plaque
A calcium score of >400 means severe plaque
What Do The CT Coronary Artery Calcium Scores Mean In Terms of Risk?
Many studies have examined in depth the prognostic significance of coronary artery calcium scores and their role in assessing risk. These are some of links from which the figures below were derived.
A calcium score of 0 is felt to be very low risk. The predicted chance of an event across studies is around 1-2% over 10 years. Of course that places people with a calcium score of zero in a low risk group.
A calcium score of 0-100 is still felt to be relatively low risk. With the predicted chance of an event over 10 years estimated to be around 2-6%
A calcium score of 101-400 signifies intermediate risk of an event. The predicted 10-year chance of an event is between 13-16%.
A calcium score of >400 signifies high risk of an event. The predicted 10-year chance of an event is between 22-29%.
A calcium score of >1000 signifies very high risk of an event. The predicted 10-year chance of an event is 37%.
CT Coronary Artery Calcium Scores In Diabetic Patients
In general, patients with diabetes are considered to be at higher cardiovascular risk than patients without diabetes. Patients with diabetes and a coronary artery calcium score greater than 0 are at higher risk than patients with similar scores and without diabetes. In patients with scores of 0, the risk is low even if patients have diabetes.
What To Do With Calcium Scores In Patients Without Symptoms?
The question often asked is should patients with higher than usual calcium scores have further testing such as stress tests. The higher the calcium score, the higher the risk of a stress test being positive. In patients with lower calcium scores and no symptoms, stress testing is generally not considered appropriate. In patients with higher scores, i.e. >400, stress testing may be more appropriate in cases. In general there is no good evidence to take patients with high calcium scores for invasive tests such as heart catheterization.
Comments are purely for informational purposes and are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Disclaimer
I had a calcium score of 1450 and past a nuclear stress test without any problems. I ‘am 59 with a strong family history of heart disease. Should i just get a regular stress test done every year and leave it alone? Or should I be under special care from a cardiologist.
I would recommend that you have a good primary care Dr that addressed risk factors and if they recommend then a cardiologist. If you have any symptoms whatsoever or need more aggressive risk factor treatment then a cardiologist may be useful also. Yearly stress tests without symptoms are not recommended in most cases, i.e there needs to be good reason to pursue stress testing and a number of appropriateness criteria exist.
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I am 54 and have Type 2 Diabetes and overweight. I started an exercise regimen 6 months ago and have lost 35 since but still need to lose ~50 more pounds. I use a c-pap machine to control my sleep apnea. I have never smoked, rarely drink and now exercise for 1 hour 3-5 days a week. No heart disease in immediate family. I have recently seen my GP who recommended i have a stress test and CT Cardiac Calcium score test done. The Treadmill stress test came back normal but my first ever CT CC score came back 113 all in the LAD. I am on a Statin, take a aspirin every day and take Lysinopril for my BP which is also normal. My Diabetes # were bad until about 3 months ago and have been under control ever since. Total Cholesterol is low but good Cholesterol is also low.
The Radiology report says i have a n estimated Arterial age of 73 with my 113 score and in the 83rd percentile which are all pretty scary to me.
my plan is to stay with and increase my exercise regime, stay on all current meds for my heart and Diabetes. I need to shed the extra weight and make it a priority. any other suggestions? is my CT CC score really that bad? your POV would be appreciated.
Sounds like you are doing an incredible job and hitting on most of the risk factors, that will be key in doing well in the long term, keep it up. Its reassuring that the stress test is normal also. Typically the calcium score is done to see how aggressive to be, in this case you are already being aggressive. Someone should be monitoring bp, cholesterol etc. I would recommend that a cardiologist review and then go over the specifics of the scan with you simply so you are well informed.
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It is great to have this arena to post questions and read other people’s experiences.
I am a 54 year old female and take medication for hashimotos, high cholesterol, and hypertension. I exercise regularly and try to eat healthy; I could stand to lose 10 – 15 lbs.
My cardiologist recommended a CT scan due to my health issues and family history.
My score was an 87 which is is the 95th percentile for females my age. This is alarming to me and confusing, since I am reading that a score of < 100 is mild evidence of CAD. I am concluding that an overall score of 87 isn't horrible, but for my age it is not good. Can you explain ? Is it that if i don't take further precautions it will just continue to get worse? My dr did increase my statin dosage as a result of the test and we are monitoring.
CT scores should be treated like any other risk marker, and i find that their best use is to trigger selection of patients that may benefit from meticulous attention to risk factors and detail rather than stoke unnecessary concern. I wouldn’t at all worry about the actual score level. Risk factor modification and ‘medical’ therapy can act to stabilize disease and improve outcomes.
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I am 62, Indian, Controlled Diabetic. Due to being diabetic and family history of heart attacks, I got my calcium score done twice last year same month in Janaury 2017. Results came :-
One Lab Another Lab
LMA 43 58
LAD 187 620
LCX 372 93
RCA 89 89
TOTAL 691 860
Both used Agatston method but LAD and LCX are markedly different. I have gone thru Echocardiogram and Stress-Echo tests twice with negative results. My Troponin is 0.001, normal range of lab being [<0.5 no indication of MI]. My Total Cholesterol is 139 and Triglyceride is 83. I am on Aspirin 81 mg and Atorvastatin 10 mg one daily. Both CT Calcium Labs had recommended Catheter Angiography but Cardiologist suggested no need for the same. However, to alleviate doubts should I go for CT Angiogram to know level of my blocks or go for Enhanced External Counterpulsation (EECP) therapy to increase the blood flow. Thanks
There is no recommended role for EECP. The decision to proceed with angiography should be determined by a cardiologist if you are felt to be at high risk and to ensure there is appropriate indication. The stress testing results are reassuring.
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I just had CT Cardiac imaging, the results came back with a score of 1943.3!, which corresponds to extensive calcification. I take and have been taking statins for 30+ years, have medicated(controlled) hypertension, no history of diabetes, After receiving my CT Cardiac imaging results, I took a CD Stress Echo. The results came back, negative ECG for ischemia with graded exercise, Duke treadmill score of 6, negative stress echo with no indication of inducible ischemia. I am 63 years old. My cardiologist says I probably have plaque all over the place, but no blockages. We are now attempting to drastically lower my LDL. Is there anything that you might suggest?
I would not suggest to become too alarmed by the calcium score rather see it as a risk marker and treat risk factors appropriately. The testing that you have had is very reassuring. You have had a normal stress test with an echocardiogram and the normal treadmill exercise test that shows as you are able to do exercise to a good capacity without significant abnormality as far as the testing is concerned. Risk factors including lifestyle, exercise, blood pressure, avoidance of smoking, treatment of diabetes if appropriate, and such things are the most important at this point. Given the known presence of disease the Statin medication is certainly appropriate.
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Dr Ahmed,
I am a CAD patient with an atypical background. I am 59, in very fit health,
140lbs, 5’10”, eat low fat, low sugar, low salt diet. I exercise some to a lot daily. Before my first MI I played basketball every week for years. No family history of heart disease. I have normal BP. I suffered a surprise MI spring 2016, 99% blocked LAD. Stented. The angiogram also reported no general CAD other than <20% thickening of the adjacent circumflex artery. Fortunately, with determined exercise and staying fit as I am able, my heart recovered decently, although my heart rate gets too high with arobic exercise (running). EF now of 45-50%. Also I take 10mg atorvastatin, 81mg aspirin, and lo dose carvidilol. Two weeks ago another surprise MI, this time circumflex 90% blocked. Second stent. Due to quick intervention, only a mild MI. EF for resting echocardiogram at 50% 3 hours post MI. But the dual stents just below the main artery must heal properly or I face bypass surgery. Here is the main question: I had radiation therapy for Hodgkin's lymphoma 22 years ago. This is a known risk factor for CAD. Would a CT Calcium scan assist in judging the health of my aorta and other arteries? I read that radiation associated CAD can make bypass surgery much more risky due to calcium and other lesions in the surgical areas. I am scheduled to get a diagnostic angiogram in 3 months to check my stents and other arteries. Would the Calcium scan be useful in this context, or a waste of time? Is the radiation from a CT Calcium scan itself a risk in my case?
Thanks in advance for your comments.
I think it is certainly a valid hypothesis that radiation could contribute to calcification in the generation of the vessels. Yes we certainly do see this in cases of patients that have had radiation can have a more aggressive form of coronary artery disease and calcification. And yes that can be more calcification of the aorta. I’m not sure what role a CT scan would have at this point. Certainly if you ever to have bypass surgery a CT scan would be able to shed light on calcification of the aorta and such and may be more useful at that time. This may be a good question to ask your treating and evaluating physician. With regard to the scan itself I’m not sure that it would worsen the natural history of the disease with the very small Associated radiation dose.
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I had a calcium test 2 yrs ago when i was 46….It came back with a score of 10, all in RCA….Do you often prescribe ACE inhibitors to help stabilize the endothelium when patients have a calcium score > 0?….
In general would pay attention to controlling risk factors. Blood pressure, cholesterol, lifestyle, exercise, diet, etc. An elevated calcium score is not an indication in isolation to start an ACE.
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Hi Dr Ahmed,
I’ve seen several articles that state a calcium scan can be affected by pulse > 90…Can this lead to false positive?….
And in a calcium scan, other than calcium deposits, does that scan show chamber sizes ascending aorta size, etc?…Are any measurements derived from a calcium scan?…
I agree..
Dr. Ahmed,
I had my husband go for the calcium scoring test because he is 57, overweight and his father had stents early on and has now had open heart at 82, along with his carotid and a heart valve replaced all at the same time! Anyway, his score was 121 with LMA and LAD being the 2 involved. What does the volume130 and AJ-130 mean? He has just started taking HTN med and chol. has been just borderline, no meds. What do you think?
Thank you so much
The results need to be interpreted within the context of the reference for this report. I wouldn’t worry about the number. In general however, the score is simply a trigger to assess the presence of a disease process and begin aggressive risk factor management which will be the key to preventing events and improving outcomes.
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Hi DR- I’m 61 years old, 6 feet tall and weigh 192, non smoker, always exercise, heart disease runs in my family. Had a 390 CAC score. Do I have anything to worry about- I breezed through my stress test below and will be discussing w my cardiologost:
uclear Cardiology
Exam Exam Date/Time
NC Exercise Perfusion Stress 03/01/2018 14:46:18 EST
Technical Comments
Reason for Test : CAD
Medications : ASA, Atorvastatin, ProAir
Exercised for ( Time ) : 11:01
Stage Obtained : 4
Reason for Terminating treadmill : SOB, Fatigue, 17 on Borg scale, 90% PMR
Base line HR : 71
Base line BP : 146/96
Max HR : 164
Max BP : 154/102
% HR Achieved : 103%
Performed By (Licensed Medical Provider) : Cheryl Anderson, APRN
Supervising Physician : Michael Logue, MD
Tc99m Sestamibi
Rest Dose : 8.9 mCi ; IV #22G LA
Stress Dose : 26.86 mCi ; IV D/C Intact
Report
Exercise Report: An intravenous with normal saline was begun prior to the
study. The patient was exercised on a treadmill using a standard Bruce
protocol. The baseline ECG showed normal sinus rhythm with nonspecific ST-
T abnormalities. ECG with exercise showed 2 mm horizontal to downsloping
ST depressions in the inferolateral leads that improved by 3 minutes of
recovery. Occasional PVCs were noted. The patient experienced no chest
pain symptoms during exercise.
Myocardial Perfusion Imaging: Stress tomographic myocardial perfusion
images were obtained and demonstrate near normal distribution of tracer
throughout the myocardium in all three projections with the exception of a
small, mild defect in the apex and apical anterior segment. These defects
improved with prone positioning. Resting images obtained earlier show
normal perfusion. The left ventricular chamber size appears normal. Polar
images confirm the absence of significant areas of ischemia. Gated SPECT
images were obtained and demonstrate normal left ventricular systolic
function with a calculated left ventricular ejection fraction of 58 %.
End diastolic volume is normal at 77 ml. Dynamic images show no focal
wall motion abnormalities. The technical quality of this study is good. The
TID ratio is normal at 0.94.
Summary:
1. Positive, ischemic ECG response to exercise at an above average
workload for age (13.4 METs) and at a diagnostic heart rate in the absence
of chest pain symptoms.
2. Abnormal myocardial perfusion with a small, mild reversible defect in
the apex and apical anterior segment that may indicate ischemia. However,
the perfusion in these segments improves on prone stress imaging,
suggesting shifting soft tissue attenuation artifact.
3. Normal left ventricular function with an ejection fraction of 58%.
4. Compared to the EKG portion of the stress echo done 2/11/15, the EKG
portion is now positive for ischemia, previously normal. Clinical
correlation advised.
***** Final Report
You have a positive exercise stress test portion of the ekg, the tracings themselves would need to be reviewed to comment, however its very reassuring that you went to 13.4 mets. In general this is certainly not a high risk finding. The perfusion test is also reassuring in that it is not high risk. Of course these decisions need to be made with a cardiologist that is actively managing this case as the symptoms need to be taken in to context. In general for such findings in disease considered stable, medical therapy would be tried in the first instance.
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Thank you so much and for taking the time to respond.
Hello, I am 50 years old and I have family genetic high blood pressure, and I just had a CAT scan with fluid done on my heart. They said they found mild calcification in different spots but all the arteries they said were widely patent and normal. Does this mean I’m going to have a heart attack or be put on a statin for mild and no blockages? Or is that such a small amount that I can just make substantial Lifestyle Changes like exercise more and eat salads and healthy foods everyday. I also have high anxiety with this and my doctor is not giving me straight answers. It kind of concerns me that something so serious nobody has contacted me in 2 weeks. I guess if there was anything really wrong they would have never let me out of the hospital and put a stent in me or some kind of other practice that would have stopped any kind of death situation I’m sure. So what does actually widely patent mean on all my arteries greater and all the rest of the ones that they had.? They said they only found mild calcification but no blockages,no dissection and no heamatoma or Aortic aneurysm. Thank you so much your insights are so fantastic I appreciate it. Thank You.
The test does not demonstrate that there are any totally blocked arteries that is good news. The presence of calcium can be used to begin the process of risk factor management and treatment. Preventative measures for the stabilization of disease. Cholesterol, diet, lifestyle, diabetes/smoking, blood pressure etc.
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I am on Diltiazam 180mg for my BP due to High spikes from my anxiety sometimes. My dad had this also for many many years his doctor said that his cause for mild calcification was not due to what he was eating or his cholesterol but more to the anxiety and stress factors and candy habits throughout his life that’s what caused the minor tears that the calcification in the aorta over the years.He ate healthy,worked out and lived to a ripe 74
I had a CT calcium test and the first year it was a 0 the second year it was a 4 the third year it was 0. I can’t find anything saying you can change that much that fast. Is the test wrong for the second year? Can anyone change that much in one year?
I’m 53 and weigh 172 lb, never smoked, hike several miles a couple times a month. My father passed away at age 62 from a likely massive heart attack. My blood pressure with Losartin and Amlopodine is in 135/85 typically, and I am on a statin. At my last physical in February, I had avoided the statin for a couple of months and had been trying an Atkins diet since August 2017 and lost about 18 lbs to my present weight, sort of to see if my cholestorol was ok. It had increased to in the 160’s. I had also had a couple of high heart rate with enough fatigue to lie down when hiking about 8 miles up hill. The guys I hike with are older than me, one had previous bypass, and they had no problems and suggested I should get this checked. My primary doctor sent me for a nuclear stress test, chest xray, and ultrasound. I was also referred to a cardiologist after these. The cardiologist said that I did well on the stress test walking for 11-12 minutes and my heart rate and blood pressure did as expected/normal, but there was a report of something in an image that might have been an artifact. In view of my family history, and perhaps that anomoly/artifact, and my previous hiking issue, they recommended that I not hike and have a cardiac catherization angiogram. As this is invasive, I went myself to a diagnostic center and had the calcium scan. This came back with several 0 scores, a 1 score, and a 40 score in the LAD with an overall score of 41. Now I am concerned that my scores are low, but appear concentrated in one artery. I also have been feeling a pressure that is really hard to define/describe at the base of my throat (not inside of my throat). Not sure if I am imagining things now…any advice on whether the risk/cost of the angiogram is really warranted?
I cant really comment on the scan without seeing it or knowing the full clinical situation. What i can tell you is that 11-12 minutes on the treadmill with no significant EKG changes or symptoms is very reassuring. I recommend that if uncertain, you obtain a second opinion on the need for cath or review of the nuclear films. High risk clinical features, imaging features or such would be a rational to proceed to cath.
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Hi Dr Ahmed am 51 year old male had cardiac and calcium scoring done 97 main artery and calcium 688 Am very tired and no engery to get up and go many thanks Alan
Have you done testing such as an exercise treadmill test?
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I have a calcium score of 1168 with zero blockage. I had a nuke stress with said results. I’m 47 and I have had 3 CT scans with my first in the 40’s to 1168 on my last in over a 9 year period. I’m interested in participating in a calcium score study if you know of any please forward my info.
49 year old male, did a calcium test a week ago and my total score was 16. Three of my arteries were 0. My blood pressure is usually 110/60 and resting heart rate is around 55. I walk/run about 15 miles everyday. I’ve had high cholesterol for 15 years and did a stress test two years ago and my arteries were free of any plague. Any concerns?
Sounds like your’e on the right track.
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I am a 61 year old male, non-smoker, BMI 29-30. I have been on statins for 30 years and have cholesterol well under control (LDL 58, total 130’s). I have a very poor family history with death from heart disease (father 55, mother 59, uncle 40’s, aunt 50’s, cousin 50’s, grandfather 50’s)
During my routine cardiologist appt a few weeks ago my dr. recommended a CT scan. He called the following day when he received the report, total 1014, with RCA at 579 and LAD at 354, LCX at 56, LMA at 25, I had a subsequent stress test with good results.
Reviewing many of the studies regarding the relationship between CAC and heart disease has me rather alarmed. Numerous large studies indicate that scores over 1000 (in asymptomatic subjects) correlate to serious cardio event risk of 20-25% within one year, and that with over 400 scores there is a 90% chance that there is at least one serious blockage (70%).
My cardiologist told me to call if I have chest pain or shortness of breath and he’ll see me again in 6 months. I am concerned with the short term risk. My father called his cardiologist a few days before a scheduled appointment and was told to wait and 2 days later was dead from an MI ( I had the privilege of finding his body and it left quite an impression on me since I was only 15).
This is creating a lot of anxiety for me. It seems that my doctor is not being aggressive enough. He did not recommend any lifestyle changes or anything, just “see you in Nov.” Given my family history and these test results I am extremely uncomfortable. I have already scheduled a second opinion but am wondering if I am overreacting.
Thanks!
The stress test is more telling in terms of the physiologic significance of the lesion. If the stress test is normal and there are no high risk symptoms, then its difficult often to justify more invasive testing. The calcium scan is used to determine how aggressive to be with risk factors. in your case with the high risk history, we would be aggressive with risk factors anyway so one could argue the calcium scan is essentially useless. Also the risk you quote of events is not accurate, no wonder you are anxious, it is nowhere near that.
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My recent ctca showed calcium score 2.2 with 10 percent occlusion in LAD. Do I need stations? I am 61 yr old female. I have him of 32. I eat healthy.
Most cardiology guidelines would recommend initiation of statins at this point.
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Recently had CT Scan total 172. But 132 is in the LAD and 40 in another location. Can you tell me what this means?