Coronary Calcium Score: What It Means (And How to Find Yours)

A few days ago, I announced my appointment to the Board of the American Heart Association. It’s an incredible honor, and only deepens my mission to equip women with the knowledge to protect their hearts!

This brings me to today’s topic: A heart health test that could help you avoid unnecessary medication (or catch risk early enough to act). And yet, many women aren’t familiar with it.

Does This Sound Familiar?

Let me set the scene:

During a routine physical, your doctor mentions that your LDL cholesterol is a little elevated. Not sky-high, but not ideal either. Maybe your total cholesterol is 220, your LDL lands in the 130s or 140s, and to top it off, you’ve got a family history of heart disease.

Now what?

Sure, statins are an option. But statins aren’t like popping an Advil. There’s a lot you need to consider, from potential side effects (muscle pain, brain fog, increased risk of diabetes, just to name a few) to the fact that it’s a lifelong medication.

Fortunately, there’s a way to get a clearer picture of your actual heart disease risk. Enter: the coronary artery calcium (CAC) test.

What’s a CAC Test?

A CAC test is a low-dose CT scan that looks for calcium deposits in the coronary arteries, which are the vessels that supply blood to your heart.

• The higher the calcium score, the more calcified plaque has built up, which means a higher risk of future heart events (such as a heart attack or stroke).
• A score of zero is a good thing. It suggests a low risk of cardiovascular events in the near future, even if your cholesterol is elevated.

If you’re unsure on whether to start statins, the CAC test can be a gamechanger. The American Heart Association and the American College of Cardiology even updated their guidelines in 2018 to recommend CAC testing as a “tie-breaker” for exactly these gray-area cases.

How to Decode a CAC Score

Here’s how to read a CAC test:

• A CAC score of 0 = your risk of a heart event is low over the next 5 to 10 years. In many cases, you won’t need a statin right now, especially if you’re otherwise healthy.
• A CAC score between 1-99 = your risk is moderate. Statins may be appropriate depending on other factors like age, family history, or diabetes.
• A CAC score of 100 or higher = your risk is high, and statins are usually recommended to reduce your risk of cardiovascular events.

The Downsides of a Coronary Artery Calcium Test

A few important caveats:

• This test isn’t for everyone. The CAC test is meant to be a decision-making tool for people who fall in the intermediate risk category (10-year risk of 7.5-20% based on the ASCVD Risk Calculator).
• A CAC scan is a CT scan. That means low-dose radiation. While it’s less than a mammogram, it’s not something you do casually or repeatedly.
• Insurance doesn’t always cover it. The out-of-pocket cost can range from $100 to $150 or more.
• A CAC scan only picks up on calcified plaque. It can’t see soft (non-calcified) plaque, which may still contribute to risk. So a CAC score of zero doesn’t guarantee you’re in the clear.

My Doctorly Advice

Would I still recommend a CAC test? Absolutely, if you’re the right type of candidate. That means you’re likely:

• Over 50
• Have borderline or mildly elevated cholesterol
• Are trying to avoid unnecessary medications but don’t want to miss early signs of heart disease

…then a CAC test is the smart next step.

What I love about the CAC test is that it brings personalization into heart care. For too long, women have been underdiagnosed and undertreated for heart disease, which is the leading cause of death for women in the United States. This test gives us concrete evidence to make smarter health decisions and ensure we're taken seriously.

It’s about time.