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Know the Score: Calcium Scoring Scans Your Heart for Hidden Dangers

A quick scan of your heart identifies your risk for cardiovascular disease and heart attack.


Concerned looking man with hands on chest while meeting with a physician A seemingly healthy person walked into The Iowa Clinic for a comprehensive executive health physical. By all appearances, they were healthy. And most of their tests came back normal — until the calcium score.

The next day, that “healthy” individual was in surgery, getting stents put into their arteries and saving them from a potentially life-threatening heart attack.

It was all caught in one quick test.

“Calcium scoring is kind of the ultimate screening for telling us how much calcific plaque is in the coronary arteries,” says Nicholas Sullivan, DO, a radiologist with The Iowa Clinic. “It’s easy to perform. It’s cost-effective. And it’s a good indicator of whether you have an issue that we need to look into further to prevent something potentially catastrophic.”

Scary! How does calcium scoring work?

Calcium scoring is a computed tomography scan of the heart — a specialized X-ray — that checks for cardiovascular disease and determines its severity. A radiologist reviews the heart CT scan and circles all the areas where calcium has built up. That information is put into a computer algorithm that delivers your calcium score on a scale of 0 to over 400.

It’s like golf. The lower your score, the better. The higher you get up the scale, the greater your risk for heart disease because there were more areas of plaque buildup found in the heart scan.

Calcium Score1,2 Implication Risk of Coronary Mery Disease
0 No identifiable plaque Very low, generally less than 5 percent
1-10 Mnimal identifiable plaque Very unlikely, less than 1D percent
11-100 Definite, at least mild atherosclerotic plaque Mid or minimal coronary narrowings likely
101-400 Definite, at least moderate atherosclerotic plaque Mid coronary artery disease highly likely. significant narrowings possible
401 or Higher Extensive atherosclerotic plaque High likelihood of at least one significant coronary narrowing
1 Mayo Clinic Proceedings, March 1999, Vol. 74. Findings based on EBCT data. 2 Carr JJ. et. al., Evaluation of Subsecond Gated Helical CT for Quantification of Coronary Artery Calcium and Comparison with Bectron Beam CT.: AJR 2DDD: 174: 915-921

“The score just puts you into different categories. Zero means no plaque at all. Then there are mild, moderate and severe categories,” says Dr. Sullivan.

If you fall into the mild or moderate categories, you’ll have to monitor your condition with additional calcium scoring tests every five years to make sure your risk hasn’t increased. If you score over 400, you’ll need to have additional testing to figure out the severity of your blockage and consult a cardiologist to see if you have heart disease.

Do I need to take a calcium scoring test?

Only if you’ve hit middle age. Calcium scoring is not recommended for males under the age of 40 and females under 50. If you’re past that point, your physician may give you a risk assessment to see whether you’re at risk of atherosclerosis — a hardening and blockage of the arteries that can lead to stroke or heart disease.

According to Dr. Sullivan, your atherosclerosis risk assessment will rank you on multiple factors:

  • Cholesterol — Your physician will look at your own cholesterol levels and any family history of high cholesterol.
  • Smoking habits — Smoking is a major risk factor for atherosclerosis, so your history or current habits play a major role.
  • Gender — Men have a higher risk than women, which is why their screening starts a full decade earlier.

If your assessment puts you at a moderate risk for significant atherosclerosis — or above — that warrants calcium scoring to actually quantify how much cholesterol is built up in your blood vessels.

What if I score high — can I lower it?

Unfortunately, not. The calcium we’re talking about is not the one from your glass of milk. It’s fat and cholesterol. When that builds up in your arteries, it calcifies — or hardens — and causes blockages.

“When you have high cholesterol, it attaches to the walls of your blood vessels and builds up over time,” says Dr. Sullivan. “As it builds it up, it actually decreases the size of your blood vessels. That decreases the blood flow that can get through and can cause a heart attack.”

And a lot of that build up is irreversible. You can make lifestyle changes so you don’t add to it and increase your cardiac calcium score and risk for heart disease. But the only way to actually get rid of the calcium is through angioplasty, a surgery to unblock or widen your arteries.

Still, Dr. Sullivan says, lifestyle changes can help you maintain your calcium score so you don’t progress into dangerous territory. Through healthier eating, cholesterol medications and decreasing controllable risk factors — like quitting smoking — you can keep your score at the same level.

Where do I get a calcium scoring test?

Start with your primary care provider. If you’re concerned about your heart health or cholesterol, talk to them about a risk assessment to see if your results warrant further testing.

If you’re an executive, calcium scoring is a core service in the comprehensive exams provided by the Executive Health Clinic. In addition to a calcium score test, you’ll get a range of tests, screenings and exams that give you a clear picture of your overall health and wellness.

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