What is Your Calcium Heart Score? Plus What to Do if You Have a High Calcium Score

Michelle Routhenstein, MS, RD, CDE

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November 1, 2024

What is Your Calcium Heart Score? Plus What to Do if You Have a High Calcium Score

Understanding your calcium score gives you a glimpse into whether you’re at an increased risk of having a heart attack. Here’s what you need to know about what a calcium heart score tells you, including what to do if you’re living with a high calcium score. Plus, if you’re wondering how to lower calcium score naturally — or if this is even possible — you’re in the right place. 

What is a Calcium Heart Score?

A calcium-score heart scan is a heart screening test used to detect calcium deposits in your coronary arteries. It’s also known by other names, like CT calcium score test, Agatston score, cardiac scan, coronary artery calcium scan (CAC), or calcium scan procedure. 

A high calcium heart score suggests a buildup of plaque in your arteries, which can increase your risk of a heart attack.

What Your Calcium Score Means

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

  • 0: 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: A 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 – which can correlate with a higher risk of heart problems. 

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’s important to be aware that even if your calcium score is 0, you can still have soft plaque in your arteries, so it doesn’t necessarily mean you’re “in the clear.” While you can’t eliminate plaque that’s already in your arteries, you can help shrink and stabilize it to avoid rupture, which can lead to arterial clots (thrombosis) that block blood flow — leading to a heart attack or a stroke.

How to Prepare

There’s not much preparation usually needed before a CT calcium score test. Your healthcare provider may ask you to avoid caffeine the day of the procedure and not wear any metal items. 

When it’s time for your scan, you will be lying flat on your back and moved into a circular machine with your arms above your head. You will be asked to hold your breath briefly, and the whole test only takes 10-15 minutes. 

Who Should Get a CT Calcium Score Test?

Having an elevated calcium score is quite common. Some studies suggest that coronary artery calcium 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), you can have a normal or athletic body build 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 to Do if You Have a High Calcium Score: 7 Tips

Lifestyle matters, especially when you have an abnormal biomarker of heart health like a high calcium score. If you’re wondering how to lower calcium score naturally, unfortunately, it’s not that simple. While you can’t directly target your calcium score, you can improve your overall heart health which, in turn, can improve biomarkers like CAC.

When someone comes to see me with a calcium score above 0, as a cardiology dietitian, my goal is to focus on a nutrient-sufficient diet that addresses several things:​​​​​​​​⁠

​​​​​​

  • Stabilizing the plaque already present in your arteries​​​​​​​​⁠
  • Preventing further promotion of plaque​​​​​​​​⁠
  • Reducing the overtaxing on the heart to allow it to optimally function to prevent heart failure, heart enlargement, and heart pumping complications.​​​​​​​​⁠
  • Optimizing all the risk factors you may have, such as lowering LDL and non-HDL cholesterol, hs-CRP inflammation markers, insulin resistance, and waist circumference​​​​​​​​⁠ to stricter standards.
  • Addressing the underlying root causes of heart disease, like inflammation, oxidative stress, insulin resistance, overweight or obesity, and plaque buildup.​​​​​​​​⁠

Furthermore, one 2013 study identified four lifestyle changes that can greatly impact your CAC score: regular exercise, a healthy diet, smoking avoidance, and weight maintenance. This combination of factors was also associated with slower calcium progression and lower all-cause mortality. In other words, there is no single food or supplement to lower calcium score; doing so requires a broad lifestyle approach. 

With that in mind, I’ve gathered 7 actionable tips I recommend taking when you have a high calcium score that can also help reduce atherogenic cholesterol and inflammation. 

1. Eat more cruciferous vegetables

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

2. Boost your omega-3 intake

Increasing omega-3 intake from foods (like fatty fish, walnuts, and flax seeds) can help reduce inflammation, a key factor in the progression of atherosclerosis. 

Omega-3 fatty acids may improve endothelial function, supporting better arterial flexibility and reducing the risk of plaque formation. They can also help lower high triglycerides, another risk factor, contributing to overall heart health when calcium deposits are present.

3. Focus on fiber

Boosting fiber intake can help lower cholesterol levels, which is crucial for heart health when you have a high calcium score. 

Soluble fiber, in particular, binds to cholesterol in the digestive system, reducing its absorption and supporting better artery health. Lowering your total and atherogenic LDL cholesterol is key for improving CAC, and fiber-rich foods can make a significant difference. 

Additionally, a high-fiber diet may help control blood sugar levels and reduce inflammation, both of which contribute to cardiovascular risk management.

4. Stop smoking

Avoiding smoking is essential when you have a high calcium score because smoking damages the blood vessels, accelerating the buildup of plaque in the arteries. 

Plus, smoking promotes inflammation and oxidative stress, which can worsen atherosclerosis and lead to further calcium deposits. Quitting smoking also reduces your risk of heart attacks and strokes.

5. Exercise regularly (and moderately)

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 think that extreme exercise may contribute to increased oxidative stress and calcium homeostasis. Plus, when exercise habits aren’t combined with science-based nutrition, it may be worse for your heart health.

Furthermore, some people are athletes and still have a high calcium score. This serves as another reminder that pairing an active lifestyle with optimal nutrition is key to reducing your risk. 

6. 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 healthcare 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 — getting your iron from food sources instead.

7. Get calcium from foods vs supplements

Calcium is an important nutrient for your bones, teeth, and other bodily functions. Research indicates that adequate dietary calcium intake may decrease the risk of atherosclerosis; however, calcium supplement use (above 500mg) may increase the risk for higher CAC. 

It’s best to take a foods-first approach with calcium, getting adequate amounts for you from sources like dark left greens, dairy products, calcium-set tofu, legumes, almonds, and calcium-fortified products.

Lowering Your Heart Score Naturally: Final Thoughts

If you are living with a high calcium score or want to take a more proactive approach to your heart health, consider joining Optimize, my next 6-week virtual heart health optimization program.

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.

FAQs

What is my life expectancy with a high calcium score?

Life expectancy with a high calcium score depends on personal factors like age, overall health, and other cardiovascular risks. Some studies have shown that patients under 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. Taking proactive steps with nutrition, exercise, and managing risk factors like cholesterol and blood pressure, can help reduce risk and potentially improve life expectancy.

This needs to be personalized to your risk assessment and taking a proactive science-based approach can increase life expectancy.

Why no caffeine before calcium scoring?

Caffeine can elevate heart rate and blood pressure, potentially affecting the accuracy of the scan. Elevated heart activity might interfere with clear imaging of the coronary arteries, making it harder to assess calcium deposits accurately.

What to do if you have a high calcium score?

If you have a high calcium score, it’s important to work with your healthcare team including a cardiovascular dietitian to manage heart disease risks. Appropriate steps include optimizing your nutrition, getting daily movement, not smoking, and taking prescribed medications if necessary. 

Does calcium intake affect my calcium score? 

Calcium intake from food or supplements does not directly affect calcium score, as the score reflects calcium deposits in the arteries rather than dietary calcium. However, excessive calcium supplementation may contribute to plaque buildup, so I recommend a foods-first approach for most people.

Sources

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