What is Your Calcium Score, and Why Does it Matter?

As part of National Heart Month, Resource editors spoke with Marcus St. John, M.D., an interventional cardiologist with Miami Cardiac & Vascular Institute who also serves as medical director of the Cardiac Catheterization Lab at Baptist Hospital. Dr. St. John explained why a patient’s calcium score is an important indicator of their future cardiovascular health.

Resource: What is calcium? Isn’t it supposed to be good for you?

Dr. St. John: Calcium has a number of benefits including being important for healthy bones and teeth. When plaque, a waxy, fatty substance, builds up inside your arteries, over time it can harden and your arteries become calcified. That’s a different kind of calcium, and it’s definitely not good for you.

Resource: What happens when plaque in one’s arteries becomes calcified?

Dr. St. John: When the plaque inside your arteries hardens, it can clog the arteries and restrict blood flow to your heart and other vital organs. Some patients with this condition might notice shortness of breath, or chest pain or discomfort known as angina. Another risk posed by plaque or calcium is if a small piece of it were to be dislodged or break free – this can lead to a blood clot which could cause a heart attack.

Resource: What is a calcium score and why does it matter?

Dr. St. John: A calcium score is a number obtained by a CT scan that can indicate if someone with no history and no symptoms already has coronary artery disease (CAD) under the radar. A low score (under 100) means your risk is low and portends a good prognosis five to 10 years out. A score of 100 to 399 is considered moderate risk; at this point your cardiologist would probably start you on statins, a widely prescribed class of drugs that lower LDL (bad) cholesterol, reduce plaque build-up in arteries and reduce inflammation in arteries. These have proven effective for patients who have or are at risk of developing CAD. You might also be put on low-dose aspirin therapy which reduces coagulation and therefore your risk of blood clot formation. A score of 400+ is considered high risk and requires the most aggressive of risk factor modification therapies and lifestyle interventions. Patients who have symptoms such as chest pain or shortness of breath with exertion may warrant stress testing or more invasive evaluation.

Resource: Can someone lower their calcium score?

Dr. St. John: Unfortunately, once measured, your calcium score doesn’t decrease. It might increase over time, however, if there is additional deposition of plaque and cholesterol in your arteries.

Resource: How is the calcium score assessed?

Dr. St. John: Your calcium score is actually determined by a state-of-the-art coronary CT angiogram, or computer tomography scan, that allows us to assess the amount of calcium in your arteries. No IV or contrasting agent is used for the study, and minimal radiation is required – even less than what is absorbed for a standard mammogram. The procedure takes just about 10 minutes and results are available quickly – usually the same day.

Resource: How can one get tested to learn their calcium score?

Dr. St. John: You could see your primary care physician, who can order a test as part of an overall assessment if you’re found to be at intermediate or high risk for CAD. Other patients self-refer to Miami Cardiac & Vascular Institute, where we do a comprehensive evaluation that includes your family history, risk factors, cholesterol levels and calcium score.

Resource: Are there other advantages to knowing one’s calcium score?

Dr. St. John: We’re starting to see cardiologists using score to assess burden of disease and to guide intensity of treatment. The calcium score is a useful tool, too, as it can estimate a patient’s risk of a “cardiovascular disease event” (such as a heart attack) in the next five to 10 years. It’s most helpful with intermediate-risk patients because it adds more information to the equation when developing a treatment plan that’s appropriate for them. It’s important, however, that people get context for their scores. A high score does not equate with a ticking time bomb or a trip to the ER. It’s simply an indicator of your future risk of suffering a heart attack, stroke or heart-related death.

Resource: What steps can someone take – starting today – to improve their cardiovascular health?

Dr. St. John: The cornerstone of cardiovascular health is what I like to call the “relentless pursuit of a heart-healthy lifestyle.” To me, that means:

• If you smoke, stop.

• Moderate your intake of sugar, salt and saturated fat.

• Go easy on processed foods; if you can’t pronounce the ingredients, it’s probably bad for you.

• Lean towards a plant-based, whole-food diet that includes plenty of fruits and vegetables.

• Get 30 minutes of brisk aerobic activity five days a week. Anything is better than nothing.

• Manage your stress and understand how it affects your heart.

• Make sure you’re getting adequate sleep – its role in heart health is well-documented.

• Get your flu and COVID-19 vaccines – if you do get sick, they’ll keep you from getting so sick that you require hospitalization.

For American Heart Month, Baptist Health is offering a simple, 30-minute coronary artery calcium test for just $49 during the month of February.