High Calcium Score: What’s Next
for Your Heart Health?

A heart attack is undoubtedly one of the most distressing complications that can cast a shadow over our hearts. However, I’ve realized that a seemingly simple calcium score can wield a similar power to disrupt lives. The news of an elevated calcium score has the potential to plunge individuals into a sea of unease and turmoil. Let’s delve deeper into the significance of this calcium score, aiming to restore some sense of calm as we navigate this territory together.


High Calcium Score: What's Next <br>for Your Heart Health? Heart Matters


The calcium score, a well-established diagnostic tool validated by extensive long-term studies, can present unsettling results when it climbs higher. Due to their elevated score, many patients are informed of a specific percentage risk of developing cardiovascular issues such as a heart attack within the next decade. The weight of being told that their calcium score equates to a 10 to 20% risk of a heart attack is a burden that can hardly be ignored. The ensuing worry and stress can be all-encompassing.


Consider a high calcium score not as an end, but as a new chapter in your heart’s journey.


It’s indeed disheartening that many patients are in swift consultations with their healthcare providers, often receiving their test results with minimal explanation of the findings.

These interactions can be as brief as:

  1. Your calcium score is elevated.
  2. You face an increased risk of a heart attack.
  3. Here’s your prescription for statins.

Does this sound familiar to some of you?

This stripped-down approach often leaves individuals grappling with the weight of their results without a deeper comprehension of the implications or an opportunity to address their concerns.

This equation often lacks a comprehensive understanding of the calcium score and its implications. This informational void frequently drives patients to seek solace and clarity from online forums. My aspiration for this article is that it can help fill this informational gap and offer a beacon of understanding.


The Calcium Score: Explained

A calcium score measures calcified plaque in coronary arteries, which can narrow and block blood flow, leading to heart issues. A chest CT scan determines it via a non-invasive coronary artery calcium scoring test. The score predicts heart disease risk and guides prevention and treatment strategies.


Interpreting a High Calcium Score

A calcium score is measured in Agatston units, with higher scores indicating more calcified plaque. The scores are typically categorized into the following ranges:

  • 0: No evidence of calcified plaque.
  • 1-10: Minimal amount of plaque.
  • 11-100: Mild plaque burden.
  • 101-400: Moderate plaque burden.
  • 400 and above: High plaque burden.


High Calcium Score: What's Next <br>for Your Heart Health? Heart Matters



The calcium score is, in essence, a numerical representation generated through a diagnostic screening test. However, it alone cannot craft a complete decision-making strategy. Instead, we must holistically consider all cardiovascular risk factors and contextualize the score. Factors like age, the extent of calcium buildup, and the individual’s overall health landscape play pivotal roles in charting the path forward.

Picture the calcium score as an X-ray CT scan designed to spot calcium deposits around and within the heart’s arteries. Calcium, a foundational component of our bones, appears white on an X-ray due to its density. The CT scan methodically inspects the arteries, spotting the presence of this calcium material. Notably, a calcium score of 0 doesn’t guarantee an absence of lipid buildup within the heart’s arteries. An individual with a score of 0 might still have some lipid buildup.

Conversely, I’ve encountered patients with high calcium scores who undergo invasive angiograms only to find no substantial arterial narrowings. Conversely, individuals with previous calcium scores of 0 have later experienced heart attacks and severe blockages. This shows why it’s important to have a detailed understanding of the situation.


High Calcium Score: What's Next <br>for Your Heart Health? Heart Matters

In the cross-section of the heart artery above, a yellow soft area denotes plaque, often without detectable calcium deposits when invasive imaging is performed. Therefore, while the calcium score does hint at calcium accumulation around arterial walls, it doesn’t inherently diagnose blockages within the arteries. A higher calcium score might suggest a heightened risk of internal plaque buildup, but this correlation isn’t absolute.


A high calcium score should never be misconstrued as a sentence of doom. Instead, it serves as a valuable signal, prompting proactive steps toward heart health. 


Approach to the calcium score

I’ve had countless patients walk into my office, burdened by distress over their results. However, the calcium score is merely one piece of the puzzle. Our approach is to comprehensively assess your overall risk profile, considering all contributing factors. A high score signifies a need for more vigilant monitoring and an intensified effort to reduce risk factors. My practice involves meticulously reviewing medical histories and scrutinizing symptoms that might hint at reduced blood flow to the heart muscle, often called ischemic symptoms. These symptoms encompass chest discomfort, radiating pain in the arms, neck, jaw, or back, and shortness of breath during exertion.

Our evaluation extends to examining cardiac risks, including blood pressure, diabetes, smoking, and lifestyle choices. These factors, alongside additional tests, shape our endeavor to minimize long-term risks and foster an active life devoid of the shackles of fear.

A comprehensive blood panel, including a cholesterol profile assessment, guides our approach. For higher calcium scores, additional tests, such as assessing lipoprotein (a) levels, could reveal long-term risk markers.

Further examinations like stress tests or CT angiography might be warranted depending on symptoms. Collaborative efforts with dieticians can tackle raised cholesterol profiles and diabetes control. Medications could enter the picture if the calcium score is elevated to stabilize plaque and prevent rupture and subsequent heart attacks.

Remember, the treatment goal isn’t to reduce the calcium score; it’s about nurturing the stability of arterial plaque to avert potential calamity.

Through risk factor management and medications like aspirin and statins, we curtail cholesterol levels and combat inflammation within arterial walls. By diminishing inflammation, we enhance the strength and stability of arterial fibrous tissue, shielding against plaque instability and the resulting heart attacks. This strategy is effective, regardless of how high the calcium score is, and offers a path forward of positivity.

Remember, contrary to what one might assume, the primary aim isn’t merely to lower the calcium CT score. Instead, the focus is on minimizing the risks associated with calcium buildup. Medications, lifestyle modifications, and risk factor management are all part of the strategy. The goal is to stabilize any existing plaque, reducing the likelihood of it causing complications like heart attacks or strokes.

While a high calcium score might introduce anxiety, it’s crucial to acknowledge that it’s only a single element in the broader canvas of heart health. It is a window into cardiovascular health, offering valuable insights into potential risks. However, it’s essential to approach this score within the context of your broader health profile. Remember, it’s not a crystal ball that predicts your fate, but rather a tool that empowers healthcare professionals to guide you toward heart-healthy choices when combined with other information.


High Calcium Score: What's Next <br>for Your Heart Health? Heart Matters



The journey forward is collaborative, exploring all facets of your health, understanding your unique risk profile, and crafting a strategy prioritizing stability and wellness. We can navigate these intricacies with dedication and guidance and empower you to lead a life free from the shackles of fear, driven by informed decisions and proactive health management. Your heart’s journey is complex but armed with knowledge, you can navigate it confidently and make informed decisions for a healthier future.



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other anti-anginals

When first-line therapies for angina, such as beta blockers, calcium channel blockers, and nitrates, prove inadequate or are not well-tolerated, second-line therapies may be considered.
Perhexiline is a unique medication that enhances the heart's ability to utilize fatty acids for energy, reducing its reliance on oxygen and lowering oxygen demand. This action helps improve blood flow and alleviates chest pain in some patients with refractory angina.
Nicorandil is another second-line option with a dual mechanism of action. It opens potassium channels in smooth muscle cells, causing vasodilation and enhancing coronary blood flow. Additionally, nicorandil also stimulates nitric oxide release, further dilating blood vessels and reducing heart workload.
Trimetazidine is an anti-ischemic agent that improves cardiac efficiency by enhancing glucose metabolism and shifting the heart's energy production to a more oxygen-efficient process. As second-line therapies, these medications offer alternative approaches for managing angina in individuals who do not respond adequately to first-line treatments or those experiencing side effects from other medications.

lipid lowering therapies

Lipid-lowering therapies play a critical role in managing coronary artery disease (CAD), a condition characterized by the narrowing of blood vessels that supply the heart. Among the most commonly discussed and debated classes of medications are statins, which effectively reduce cholesterol levels and are widely prescribed to lower the risk of cardiovascular events. Alongside statins, other medications like ezetimibe, fibrates, and niacin are also utilized to target specific aspects of lipid metabolism, such as cholesterol absorption, triglyceride levels, and raising high-density lipoprotein (HDL) cholesterol. Additionally, the introduction of medications that inhibit PCSK9, an enzyme involved in cholesterol metabolism, has provided a promising new approach to further lower LDL cholesterol levels. These PCSK9 inhibitors, such as Repatha (evolocumab), have shown significant efficacy in reducing LDL cholesterol levels in patients with CAD, especially for those who may not respond well to traditional therapies.


Nitrates are widely used to treat angina and provide quick relief for chest pain. Commonly available in the form of sublingual sprays or tablets, patches, and long-acting tablets, nitrates work by dilating blood vessels, allowing for increased blood flow and reduced resistance. This dilation eases the heart's workload, leading to a decreased demand for oxygen and prompt alleviation of angina symptoms. Sublingual nitrates act rapidly and are often used to provide immediate relief during angina attacks, while patches and long-acting tablets are employed for preventive purposes. However, nitrates may cause side effects such as headaches, dizziness, and flushing, which usually subside over time.

calcium channel blockers

Calcium channel blockers, including amlodipine, felodipine, cardizem (diltiazem), and verapamil, are commonly prescribed for the treatment of angina. These medications work by inhibiting the influx of calcium into the muscle cells of the heart and blood vessels, leading to their relaxation. As a result, blood vessels widen, promoting improved blood flow and reduced blood pressure. In the context of angina, this relaxation decreases the heart's workload, lowering the demand for oxygen and alleviating chest pain. Calcium channel blockers offer a valuable treatment option for individuals with angina, but it is essential to be aware of potential side effects, which may include headaches, dizziness, flushing, and ankle swelling.

Beta blockers

Beta blockers, such as metoprolol, propranolol, atenolol, carvedilol, and bisoprolol, play a crucial role in treating angina. By blocking certain receptors in the heart, they effectively reduce heart rate and the force of contraction, thereby easing the heart's workload. This mechanism of action leads to a decreased demand for oxygen, making beta blockers highly effective in relieving chest pain associated with angina. As with any medication, it's important to consider potential side effects, including tiredness, worsened asthma, erectile dysfunction in some males, and more vivid dreams during sleep. Consult your healthcare provider to determine the suitability of beta blockers for managing your angina and overall heart health.

Anti-platelet Medications

Anti-platelet medications play a crucial role in preventing blood clot formation, reducing the risk of serious cardiovascular events such as heart attacks and strokes. Among the widely used anti-platelet drugs are aspirin, clopidogrel, and ticagrelor.

Aspirin: This well-known medication inhibits platelet activation, making it less likely for platelets to stick together and form clots. Aspirin is commonly used for primary and secondary prevention of heart attacks and strokes.

Clopidogrel: As a potent anti-platelet agent, clopidogrel works by blocking specific receptors on platelets, preventing them from aggregating. It is often prescribed to patients with acute coronary syndrome, those undergoing stent procedures, and for some cases of peripheral arterial disease.

Ticagrelor: Ticagrelor is another effective anti-platelet drug that works by inhibiting platelet activation. It is used in acute coronary syndrome, often given alongside aspirin to reduce the risk of heart-related events.