Have a high calcium score? Here’s what to do

Michelle Routhenstein, MS, RD, CDE


October 3, 2022

A calcium-score heart scan is a heart screening test that is used to detect calcium deposits in your coronary arteries. Having a high calcium score suggests that you have a buildup of plaque in your arteries which can increase your risk of a heart attack.

It’s important to understand your calcium score to see whether you are at an increased risk of developing coronary artery disease. Making certain lifestyle changes can slow the progression of heart disease and help to prevent further heart complications.

What is a calcium score scan?

Calcium is an important nutrient for the health of your bones and teeth. However, when your arteries contain hardened calcium deposits, fat, and cholesterol, also known as plaque, it can contribute to narrowing, and overtime, restrict blood flow to your heart or other vital organs.

Cardiac calcium score scans are non-invasive tests that are used to detect the buildup of plaque on the walls of your coronary arteries. The test can identify coronary artery disease before you may feel symptoms and can also determine the severity of the disease.

During the 10 to 15-minute heart scan, a computer tomography (CT) scanner will rotate around your body while a computer creates a detailed 3D image of your heart.  

Typically, a radiologist or cardiologist will interpret the scan results and share their findings with you.

Other names that people may use to refer to a calcium score scan may include: ​​

  • Agaston score
  • Cardiac scan
  • Heart scan
  • Coronary calcium scan
  • Coronary artery calcium scan
  • Calcium scan procedure
  • Cardiac CT for calcium scoring

Prepping for a calcium score scan

There is no special preparation that needs to be done prior to a calcium score scan. You can take your medications as usual on the day of the exam but you will be asked to avoid any caffeinated food or beverages.

You may be wondering why you should have no caffeine before a calcium scoring scan. This is because ingesting caffeine can make your heart beat faster, which can interfere with test imaging.

Who should get a cardiac calcium score test?

Having an elevated calcium score is quite common. In fact, some studies suggest that coronary artery calcium (CAC) may be present in half of all men between the ages of 45 to 60 years old, and a quarter of women within the same age group.

Cardiac calcium scoring is recommended for men ages 40 to 65 and women ages 45 to 70 with one or more of the following risk factors:

  • Diabetes
  • Past or current smoker
  • Obesity
  • Family history of heart disease
  • LDL cholesterol level greater than 160mg/dL
  • Blood pressure greater than 140/90mmHg
  • Inactive lifestyle
  • Ethnicity (Research suggests that people who are white are more likely than other races to have a coronary calcification score of greater than zero.)

While obesity is a risk factor for coronary artery disease (CAD), it’s important to note that you can have an ideal body weight and still have a high calcium score.

A calcium score test can be retaken depending on the results. For example, if your score is zero, you may consider repeating the test every five years. If your test indicates some calcium buildup, you may consider repeating the test every two years. 

What does my cardiac calcium score mean?

Your calcium score is calculated based on the amount of calcified plaque seen in your CT scan.

Your likelihood of having heart disease or a heart attack correlates with your calcium score. For example, based on the calcium score and your age, it will indicate the likelihood of you having a cardiac event when matched and compared to other men or women your age.

The higher the cardiac calcium score, the more plaque buildup you have in your arteries, which increases your chance of having a heart attack.

You can interpret your calcium heart score based on the following ranges:

  • Zero: No plaque and your risk of heart attack is low.
  • 1 – 10: Small amount of plaque. Less than a 10 percent chance of having heart disease, and your risk of heart attack remains low. However, anything above zero should be addressed.
  • 11-100: Some plaque. Mild heart disease and a moderate chance of heart attack. 
  • 101 – 400: Moderate amount of plaque. Suggests heart disease and plaque may be blocking an artery. The chances of having a heart attack are moderate to high. 
  • Over 400: Large amount of plaque. Greater than a 90% chance that plaque is blocking arteries and the risk of having a heart attack is high. 

Your cardiac calcium score can also be used to estimate your arterial age. For example, you may be 50 years old, but a higher calcium score may indicate that your arteries are more consistent with an arterial age of 60 years old.

Additionally, studies show that CAC scores may be used as a tool to help identify people with elevated blood pressure who are at high risk for coronary heart disease, stroke, and heart failure. CAC scores can help guide decisions on treatment options including how proactive lifestyle intervention should be and for the use of medications, as indicated by your medical team.

It is important to note that many brilliant cardiologists I have worked closely with agree that a proactive approach should be taken when your calcium score is above 0 since there is an indication that there is hardened plaque present and a potential risk for a cardiovascular event.

What is my life expectancy with a high calcium score?

You may be wondering what your life expectancy is with a high calcium score. Some studies have shown that patients under the age of 50 with a high calcium score were predicted to live roughly 5 years less than similarly aged patients with scores of zero.

Current research shows that there is a strong link between CAC progression and the risk of heart failure. Heart failure has a grim prognosis if not addressed timely.  To learn more about the difference between heart attacks and heart failure, feel free to read a previous article here.

A calcium score test detects only calcified, or hardened plaques, not softened plaques. Soft plaque is made of fat, cholesterol, and blood-clotting material, and even though it’s not hardened yet, it can still contribute to a narrowing of your arterial walls.

It’s important to note that any score above zero should be addressed. While you can’t eliminate plaque that’s already in your arteries, you can help shrink and stabilize it to avoid rupture. Rupturing of plaque can lead to arterial clots (thrombosis) which can block local blood flow completely, or can cause dangerous blockages elsewhere in your body, leading to a heart attack or a stroke.

How to lower calcium score naturally

While any score above zero is not ideal, there are lifestyle changes you can make to mitigate your risk. For example, there are foods you will want to limit to avoid the promotion of more plaque in the arteries and therapeutic foods you should add to your diet to promote artery health, enhance plaque stabilization, and optimize heart functioning to reduce your risk of a cardiac event. I discuss this at length in my 6 week heart optimization group program.

If you have a high calcium score, you’ll want to be proactive in optimizing all of your risk factors and blood tests, particularly cholesterol and blood pressure. 

Target levels include:

  • LDL less than 70mg/dL
  • Non-HDL less than 100mg/dL
  • HsCRP less than 1.0mg/dL
  • Triglycerides less than 100mg/dL
  • BP less than 120/80mmHg, ideally 110/70mmHg

The following are a couple tips on how to lower your calcium score naturally:

Skip the low-carb craze and include a sufficient amount of whole grains

While low carb diets tend to get a lot of attention, you may want to consider adding whole grains to your diet rather than eliminating carbs. One 2020 study found that low-carb diets are linked with an increased risk of CAC progression, particularly when animal protein or fat are chosen to replace carbohydrates.

Increase your dietary calcium intake but reconsider your calcium supplement 

Research indicates that high dietary calcium intake may decrease the risk of atherosclerosis, however, calcium supplement use (above 500mg) may increase the risk for higher CAC.

Increase your intake of cruciferous vegetables

Cruciferous and allium vegetables including cabbage, Brussel sprouts, cauliflower, broccoli onions, leeks, garlic, chives, and shallots all contain compounds that have been linked to a  reduction in inflammation and oxidative stress and a decreased risk of atherosclerotic vascular disease mortality. 

Make necessary lifestyle modifications

Studies have identified four lifestyle changes that can make a big impact on your CAC score. In one 2013 study, researchers found that a combination of regular exercise, a healthy diet, smoking avoidance, and weight maintenance was associated with a lower calcium score, slower calcium progression, and lower all-cause mortality.

Stick to moderate versus extreme exercising 

While reduced cardiovascular fitness can be a predictor of future cardiovascular events, steering clear from extreme exercise may help protect your heart. Research has linked extreme exercise with increased CAC scores. Scientists theorize that extreme exercise may contribute to increased inflammation which can compromise heart health.

Reconsider iron supplementation 

One 2012 study investigated whether there was any relationship between ferritin (a blood protein that contains iron) and coronary artery calcium scores. Researchers found that increased ferritin levels were associated with increased CAC scores and in turn, coronary artery atherosclerosis.

Considering how iron supplementation can increase ferritin levels, you may speak with your health care professional about the continued need for supplementation if you have an elevated CAC score. An iron supplement can help correct deficiencies but the cause of low iron levels should be addressed so long term iron supplementation can be avoided.

Get help lowering your calcium score

If you have an elevated calcium cardiac score or want to take a more proactive approach in your heart health, consider joining my next 6 week virtual heart health optimization program to help reduce your risk of a cardiovascular event and optimize your heart functioning.

Additionally, I offer 1 on 1 personalized services to help support your heart health, achieve your specific goals, and stop the progression of coronary artery disease through science-based, personalized nutrition. You can improve your cardiac health with the right tools and support.


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