Coronary calcium scoring is one of the most widely used tools to assess cardiovascular risk, yet it often causes more confusion and anxiety than clarity. As a cardiologist, I have witnessed firsthand the uncertainty many patients feel when presented with their calcium score. For some, a high number sparks alarm. For others, a score of zero brings false reassurance. The key message I share with every patient is this: you are not defined by a number.
What is a Coronary Calcium Score?
A coronary calcium score is derived from a noninvasive CT scan that measures the amount of calcified plaque in the coronary arteries. These are the arteries that supply blood to the heart muscle. Calcium in the artery walls is a marker of atherosclerosis — the build up of plaque over time.
The scan provides a numerical value, often ranging from 0 (no detectable calcium) to well into the thousands. But it is important to understand that this score is just one part of a much bigger picture.
Why It Can Cause Worry
Many risk calculators used in heart health care are designed to estimate the long term risk of a heart attack or stroke, often expressed as a percentage over five or ten years. While helpful in some respects, these numbers can also unintentionally heighten worry and stress. I have had patients arrive at clinic deeply concerned, convinced their life is on borrowed time because of a high calcium score.
The truth is more nuanced. A high score is a signal to pay attention, not a sentence. Likewise, a score of zero does not always mean you are in the clear.
What the Number Does and Does Not Tell Us
A calcium score reflects the burden of calcified plaque — the hard, rock like deposits that accumulate over time in response to inflammation and damage in the arteries. These are usually stable and less likely to rupture. Ironically, the plaques that are most dangerous are often the soft ones, made up of lipids and inflammatory cells. These are the ones that may not contain any calcium and can still cause a sudden blockage and heart attack.
So yes, you can have a calcium score of zero and still have significant soft plaque that has not yet calcified. This is especially true in younger individuals or people with rapidly progressing disease.
Conversely, I have cared for patients with calcium scores in the thousands who, upon undergoing invasive coronary angiography — the most definitive test for blocked arteries, were found to have no major narrowing at all.
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Moving Beyond the Score
It is worth repeating: do not let a number dictate your life. Whether your calcium score is zero, 100, or 2000, it is only one marker of risk. What truly matters is what we do with that information.
This includes:
- Reviewing your full risk profile: blood pressure, cholesterol, diabetes status, smoking history, family history, and lifestyle
- Understanding your symptoms: Are you experiencing chest discomfort, breathlessness, or fatigue with exertion? These matter more than the scan alone
- Using additional tests if needed: In some cases, a stress test, coronary CT angiogram, or even an invasive angiogram may be required for further evaluation
- Focusing on what you can control: Regular activity, heart healthy eating, stopping smoking, managing weight, and using the right medications where needed
A Tool, Not a Verdict
The calcium score is a valuable tool. But it is just that, a tool, not a verdict. It gives us insight into long term risk and can guide decisions on whether to start or intensify treatments like cholesterol lowering medications. But it must always be interpreted in context, alongside clinical judgement and the whole patient story.
Reassurance and Perspective
I often tell my patients that we are in a much stronger position than we used to be. We now have powerful strategies to manage cardiovascular risk. And even if your calcium score is high, that does not mean a heart attack is inevitable. It means we have an opportunity , a chance to take action early and protect your heart.
So if you are worried about your calcium score, please know this: you are not alone, and you are not helpless. With the right approach, you can take control and lead a full and healthy life.
Peter is an interventional cardiologist and the Founding Editor of Heart Matters, a trusted resource for heart health education. With more than 20 years of clinical experience, he is dedicated to making cardiovascular care more understandable and accessible. His work bridges patient care, research, and public education, empowering individuals to take control of their heart health. Professor Barlis is internationally recognised for his contributions to cardiology, with numerous publications and speaking engagements around the world.
