Heart Health
Concern about rising calcium score
Ask the doctor
- Reviewed by Christopher P. Cannon, MD, Editor in Chief, Harvard Heart Letter; Editorial Advisory Board Member, Harvard Health Publishing
Q. I am a 70-year-old man with a strong family history of serious, often fatal coronary artery disease. I exercise daily and eat a healthy, plant-based diet. My BMI is 21, and although my cholesterol has always been low, I started taking a statin in 2018. In 2019, I got a calcium scan and my score was 290. A repeat test in 2022 showed a score of 385. What else can I do to control the calcium buildup?
A. Your healthy habits sound right on track. And given your family history, getting a CT scan to check for coronary artery disease is a good plan. But as I explain to my patients, the name of the test — a coronary calcium scan, or just calcium scan — can give the wrong impression. We look for calcium on the scan, but calcium is not actually the problem — it's the cholesterol. Plaque that builds up inside an artery contains a central core of cholesterol, lots of inflammatory cells, some fibrotic cells (scar tissue), and calcium deposits. On a CT scan, the cholesterol is not visible, but the calcium is very easy to see. Because there's a close correlation between the amount of calcium and the amount of plaque, a calcium score is a good indicator of the amount of plaque.
Treatments for coronary artery disease aim to reduce the cholesterol inside the plaque and replace it with scar tissue, which forms a thick cap on top of the cholesterol. That reduces the chance that the plaque will break open and cause a heart attack or stroke. However, there is more calcium in these stabilized plaques, which means an increase in calcium in a person receiving treatment can be a good finding.
Other tests can provide more detailed pictures of plaque inside the heart's arteries. Cardiac CT angiography uses a special dye visible on x-rays to create a three-dimensional view of the heart's arteries. Even more sophisticated tests use artificial intelligence–based algorithms that can identify the different components within the plaque; two leading tests are Cleerly and HeartFlow. However, this type of testing is not included in the current guidelines for assessing coronary disease. Studies are under way to monitor improvements in the plaque and see if such information can help guide treatment.
For people like you with a high risk of coronary artery disease, we recommend an LDL cholesterol value of less than 70 milligrams per deciliter, but the lower the better. I also suggest that you check your blood level of Lp(a), which is another type of "bad" cholesterol that contributes to plaque (see "The latest on lipoprotein (a), an inherited cause of early heart disease" in the February 2023 Heart Letter).
Chest scan image courtesy of Ronald Blankstein, MD
About the Reviewer
Christopher P. Cannon, MD, Editor in Chief, Harvard Heart Letter; Editorial Advisory Board Member, Harvard Health Publishing
Disclaimer:
As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles.
No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.
