Coronary Artery Calcium Score - CAC Scoring Explained (2022)

Estimated reading time: 8 minutes

Measurements of coronary artery calcium score (CAC scoring) are commonly used to assess future heart disease risk.

When we age, calcium deposits can be found in many parts of our bodies. Calcification in the arterial walls is common in people aged 65 and older.

Coronary Artery Calcium Score - CAC Scoring Explained (1)

So, to some degree, calcification of arteries can be regarded as a normal part of aging.

Due to their metallic nature and density, calcium deposits are easily detected by X-ray images.

Today, a heart scan, also known as a coronary calcium scan, is used to assess the amount of calcium in the coronary arteries.

Coronary ArteryDisease

To be able to function normally, the heart needs a continuous supply of oxygen and other nutrients. The coronary arteries play an essential role in delivering these nutrients to the heart muscle.

Unfortunately, the coronary arteries are prone to a disease called atherosclerosis.

Atherosclerosis is a chronic inflammatory condition in which plaque builds up inside the arteries. A plaque is made up of inflammatory cells, cholesterol, calcium, and other substances.

(Video) Coronary Artery Calcium Scan (Calcium Heart Score) Explained

Plaques in the coronary arteries may block blood flow to the heart muscle, leading to chest pain symptoms.

Furthermore, plaques may rupture, leading blood clotting at the plaque site. This may cause a sudden disruption of blood flow, leading to a heart attack.

In the early 1960s, several risk factors for coronary artery disease were defined. Since then, it has repeatedly been documented that smoking, highLDL-cholesterol, andhigh blood pressureare associated with increased risk.

Examples of other conditions that predispose to coronary artery disease are family history, insulin resistance, physical inactivity, mental stress, and depression.

Coronary heart disease remains the most common cause of death in the Western world. Hence, identifying individuals at risk is a significant step to reduce the burden of this disease.

Measuring the amount of calcium in the coronary arteries by CT scan may provide important information about the presence of coronary artery disease.

Coronary ArteryCalcification

Most of us will ultimately get calcification in our arteries as we age. Hence, calcification of the coronary arteries can be regarded as an aging phenomenon.

However, if the amount of calcium is higher than expected by age, it may reflect an increased heart attack risk.

Coronary calcification can be seen in adolescents, although it usually starts later in life.

For many years, arterial calcification was thought to result from a degenerative process associated with aging. However, recent evidence suggests a more active process, likely arising from inflammation of the vessel wall.

Coronary Calcium Score

In the 1980s, US cardiologists lead by Dr. Arthur Agatston studied how to assess the amount of calcium in the coronary arteries.

Using an ultrafast CT scan technique, Agatston defined a method to calculate coronary artery calcium score (CAC score).

Initially, the CAC score was called the Agatston score,

Coronary Artery Calcium Score - CAC Scoring Explained (2)

CAC score is an important tool to predict heart attack risk and other vascular events (2).

(Video) Calcium Score Heart Scan, Animation

Furthermore, it may help to detect the presence and extent of coronary artery disease.

Nonetheless, the CAC score does not reflect the presence or absence of blockages or impaired blood flow in the arteries.

Still, a patient with a high CAC score is more likely to block a coronary artery than a patient with a low CAC score.

An individual with a CAC score of zero is very unlikely to have a severe blockage of a coronary artery.

Coronary Calcium Score Interpretation

The following definitions are used to relate the CAC score to the extent of underlying coronary artery disease (3):

  • Coronary calcium score 0: No identifiable coronary artery disease.
  • Coronary calcium score 1-99: Mild coronary artery disease.
  • Coronary calcium score 101-400: Moderate coronary artery disease.
  • Coronary calcium score > 400: Extensive coronary artery disease.

When interpreting the CAC score, it is essential to consider age and gender. Women, in general, have lower calcium scores than men.

A calcium score calculator is availableherethat provides CAC score distribution based on age, gender, and ethnicity.

Using CAC Score to Assess Arterial Age

CAC score increases with age. Hence, at a certain age, we will be expected to have a specific CAC score that would be considered normal for that age. This score would then reflect the age of our arteries or the arterial age.

If everything is normal, we would expect our arterial age to be the same as our observed age.

However, if the CAC score is high, our arterial age may be higher than our observed age. Conversely, if our CAC score is low, the arterial age may be lower than our observed age.

The table below shows how arterial age can be predicted from the CAC score (4).

Coronary Artery Calcium Score - CAC Scoring Explained (3)

Let’s take an example.

A 60-year-old man has a CAC score of 500. According to the table above, his arterial age will be 84 years.

(Video) Scoring coronary artery calcium (CAC) with cardiac CT

Hence, this 60-year-old man has arteries that are consistent with the arteries of an 84-year-old man.

Arterial age based on the CAC score can also be calculated here.

When Should CAC Scoring Be Performed?

Coronary calcium score guidelines don’t recommend routine use of CAC scoring in asymptomatic individuals (5).

However, the CAC score may be useful for individuals at increased risk based on the ASCVD score.

The ASCVD score is based on several parameters such as gender, race, cholesterol levels, blood pressure, smoking, and the presence of diabetes.

ASCVD score can be calculated here.

Hence, if ASCVD score is between 5-20 percent, CAC scoring may help to guide further therapy.

CAC scoring is not recommended in individuals with ASCVD risk below 5 percent.

How Is Coronary Calcium Assessment Performed?

Lately, ultrafast spiral CT has been used to assess coronary calcium. This technique, often called heart scan, makes the scanning time very short.

The patient usually needs no specific preparation. Fasting is not necessary.

As high heart rate may reduce imaging quality, patients are often asked to refrain from smoking and drinking coffee before the scan. Sometimes beta-blockers are administered to slow heart rate.

Many experts have expressed concerns about the radiation involved with the CT scan. It has been estimated that there may be an increase in cancer risk with repeated procedures (6).

What to Do AboutExtensive Coronary Calcification?

There is no specific treatment available that lowers coronary calcium.

Treatment of individuals with high calcium scores should aim at reducing risk. This involves treating lipid disorders, high blood pressure, and diabetes if present.

(Video) What Your Coronary Artery Calcium Score Means

Due to the overwhelming evidence of benefit in individuals with coronary artery disease, treatment withaspirinandstatinsis often advised.

Refraining from smoking is essential, and regular, moderate exercise is advised.

Further evaluation may be needed if extensive calcification is present.

Coronary Calcium Score and Statins

Treatment with statins is often advised for patients with a high CAC score. This is based on their ability to reduce plaque size and improve clinical outcomes.

Interestingly, however, statins do not reduce calcifications in the coronary arteries. In fact, some studies suggest that statins may promote coronary calcification (7).

The fact that the CAC score is associated with increased risk does not prove that calcium itself is harmful. It is simply a marker of underlying coronary artery disease.

Patients with high CAC scores have simply had their coronary artery disease detected by the high amount of coronary calcium. The calcium itself is not the problem. Indeed, it has been suggested that the calcium may represent shrinkage and stabilization of plaques (8).

Statins are often recommended if the CAC score is above 100.

Conversely, statin therapy is not recommended in patients with a CAC score of zero.

The Role of Calcium and K2 Supplements

Inadequate calcium intake can lead to decreased bone density, thereby increasing the risk of osteoporosis and bone fractures.

Supplemental calcium can increase bone mineral density and bone strength. However, recent data suggests that high consumption of calcium supplements may increase calcification of the arteries (9).

Hence, it has been suggested that elevated consumption of calcium supplements may raise the risk of heart disease.

Vitamin K2 deficiency is associated with an increased risk of calcification of the blood vessels. Furthermore, researh indicates that the use of vitamin K2 supplements is associated with decreased arterial calcification (10).

Hence, increased intake of vitamin K2 might help to reduce the health risks associated with coronary calcium.

(Video) Coronary Calcium Score: Basics and Beyond

However, further studies are needed to establish the role of K2 supplements in people with high CAC score.

The article was initially published August 19, 2014.

It was revised, updated and republished on December 20th, 2020.


How do I interpret my calcium score? ›

  1. A score of zero means no calcium is seen in the heart. ...
  2. When calcium is present, the higher the score, the higher your risk of heart disease.
  3. A score of 100 to 300 means moderate plaque deposits. ...
  4. A score greater than 300 is a sign of very high to severe disease and heart attack risk.
23 Jul 2021

What is a normal calcium score for a 70 year old woman? ›

At any age, 0 is the ideal and normal calcium score. A score of 0 means no “calcified” plaque exists in the coronary arteries. However, it is imperative to note that if you have “non-calcified” plaques, the score would still be 0, but falsely reassuring.

What is the average calcium score for a 75 year old male? ›

The median score increased with age in both men and women but, in women, the score lagged about 10 years behind the men (Figure 2). For example, the score was 542 for women aged 85 to 99 years compared with 539 in men aged 75 to 79 years.

Can you have a high calcium score and no blockage? ›

Instead, a calcium score measures the amount of calcium in your coronary arteries. It doesn't tell us that any of your arteries are actually blocked or detect where blockages might occur. Your calcium heart score also doesn't tell us your absolute heart attack risk.

Can you lower your CAC score? ›

If your calcium score is high, medication and procedures that remove plaque from the heart can lower the score.

What is normal CAC? ›

1-10 = calcium detected in extremely minimal levels (risk of coronary diseases is still low – less than 10%) 11-100 = mild levels of plaque detected with certainty (minimal narrowing of heart arteries is likely) 101-300 = moderate levels of plaque detected (relatively high risk of a heart attack within 3-5 years)

Do statins reduce calcium score? ›

Statins do not reduce or enhance CAC as measured by Agatston scores in asymptomatic populations at high risk of cardiovascular diseases, but seem to slow down their CAC progression.

Can you reverse calcium buildup in arteries? ›

You can absolutely prevent CAD from worsening, and with some hard work, you might even be able to reverse some of the damage, says Gregg Fonarow, MD. He's the co-director of the UCLA Preventative Cardiology Program at the David Geffen School of Medicine and a spokesperson for the American Heart Association.

Can vitamin D cause calcification of arteries? ›

Experimental studies have shown that excessive vitamin D activities can induce vascular calcification, and such vascular pathology can be reversed by reducing vitamin D activities. The human relevance of these experimental studies is not clear, as vitamin D toxicity is relatively rare in the general population.

How often should you have a calcium score test? ›

If you have a very low or high calcium score, it is unlikely to change, but if your score is moderate it can be worth repeating the scan to see if it has changed. We might recommend another scan in 2-5 years as well as some lifestyle changes to protect your arteries.

Can you live long with a high calcium score? ›

In models estimating patient life expectancy, patients <50 years of age with a high-risk calcium score would be expected to live nearly 5 years less than that of younger, non-smokers.

How accurate is a calcium score test? ›

In general, calcium scans are very accurate. Unlike some other imaging tests, the results are unlikely to be either falsely negative (that is, the test indicates no problem when there actually is one) or falsely positive (the test indicates a problem when there isn't).

Can stress raise your calcium score? ›

This study measured volunteers' levels of cortisol, a stress hormone, while they carried out tests aimed at raising their stress levels. It found that people who had increased cortisol levels were more likely to have high calcium deposits in the arteries, a marker of coronary heart disease.

Does exercise clear arteries? ›

A. Yes, lifestyle changes, including diet, smoking cessation, stress management and exercise, can decrease the size of atherosclerotic plaques. They can also help to stabilize them so that they are less likely to break off and block blood flow, decreasing your risk of a heart attack.

Is it OK to exercise with a high calcium score? ›

The good news from this study, Dr. DeFina says, is that even if that scan should reveal a high calcium score, it appears that most people “safely can and should continue to exercise.”

What foods reduce calcium score? ›

Some of the best foods for helping to reduce your coronary calcium score include:
  • Avocados.
  • Nuts.
  • Fish.
  • Olive oil.
  • Coffee.
  • Soy proteins.
  • Garlic.
  • High-fiber foods.

What foods reduce calcification? ›

Fruits And Vegetables With Higher Potassium Levels May Help Reduce Arterial Sclerosis And Calcification. Scientists publishing a new study in the journal JCI Insight have concluded that high-potassium foods such as avocados and bananas protect the arteries against hardening or calcification.

What is a good CAC value? ›

What is a good CAC:LTV Ratio? Ideally, LTV/CAC ratio should be 3:1, which means you should make 3x of what you would spend in acquiring customers. If your LTV/CAC is less than 3, it's your business sending out a smoke signal! It's an indicator to try and reduce your marketing expenses.

What is a good CAC number? ›

CAC measures the cost to acquire an individual customer while CPA, cost per acquisition, measures the cost to acquire something like registration and user activation. What is a good CAC? A good Lifetime Value to Customer Acquisition cost ratio is usually 3 to 1.

What is considered a good CAC? ›

A good benchmark for LTV to CAC ratio is 3:1 or better. Generally, 4:1 or higher indicates a great business model. If your ratio is 5:1 or higher, you could be growing faster and are likely under-investing in marketing.

At what calcium score should you start a statin? ›

According to the guideline, a CAC score of 1 to 99 favors statin therapy, especially in those ≥55 years of age. For any patient, if the CAC score is ≥100 Agatston units or ≥75th percentile, statin therapy is indicated unless otherwise deferred by the outcome of clinician-patient risk discussion.

Can you reverse your calcium score? ›

St. John: Unfortunately, once measured, your calcium score doesn't decrease. It might increase over time, however, if there is additional deposition of plaque and cholesterol in your arteries.

What increases calcium score? ›

The median CAC score increased in the following order: statin group, statin and PCSK9 group, and no-statin-no-PCSK9 group. Annual CAC score progression was 29.7% by statin monotherapy and 14.3% following the addition of the PCSK9 inhibitor to statin therapy.

Does anything dissolve plaque in arteries? ›

The key is lowering LDL and making lifestyle changes.

"Making plaque disappear is not possible, but we can shrink and stabilize it," says cardiologist Dr. Christopher Cannon, a Harvard Medical School professor. Plaque forms when cholesterol (above, in yellow) lodges in the wall of the artery.

What supplement removes plaque from arteries? ›

Niacin, or Vitamin B3, is the best agent known to raise blood levels of HDL, which helps remove cholesterol deposits from the artery walls.

How do you remove plaque from arteries naturally? ›

You can “unclog” your arteries with natural methods, including diet, exercise, and stress management. Quitting smoking, if you smoke, can also help reverse plaque.
This includes eating a diet that consists of:
  1. grains.
  2. legumes.
  3. vegetables.
  4. fruits.
  5. nuts.
  6. seeds.

Can too much d3 cause calcification? ›

The main consequence of vitamin D toxicity is a buildup of calcium in your blood (hypercalcemia), which can cause nausea and vomiting, weakness, and frequent urination. Vitamin D toxicity might progress to bone pain and kidney problems, such as the formation of calcium stones.

Can Vitamin K2 reverse calcification? ›

Thus, Vitamin K-2 acts as an essential cofactor to prevent calcification of our blood vessels. This vital fact is only recently understood. Vitamin K-2 acts to prevent calcification of arteries, and it can reverse calcification after it happens.

Does milk cause plaque in arteries? ›

High milk consumption is also a risk factor for IMT thickening (OR = 1.15, 95%CI 1.08–1.23), carotid plaque formation (OR = 1.17, 95%CI 1.09–1.25) and carotid stenosis over 50% (OR = 1.52, 95%CI 1.10–2.14) in the propensity score-matched population.

Is a coronary calcium scan worth it? ›

"A calcium scan is very useful if there's uncertainty about a person's risk of heart disease or the need for statins," he says. Recent studies show that findings from a calcium scan can help refine and sometimes reclassify a person's risk of cardiovascular disease.

What food causes calcium buildup in arteries? ›

The study, published Aug. 13 in Science, suggests that consuming food rich in saturated fat and choline - a nutrient found in red meat, eggs and dairy products - increases the number of metabolites that build plaques in the arteries.

Is calcium score related to cholesterol? ›

Having both a high CAC score and high cholesterol levels could increase a person's risk of developing heart disease, but having one high score does not necessarily mean that a person will have a high score for the other. In fact, a person can have high cholesterol and a zero CAC score.

What does a calcium score of 3000 mean? ›

Diagnosis in a Heartbeat

The higher the calcium score, the more imminent the danger of a heart attack. Patients who have scores over 400 are more likely to develop heart disease symptoms within two to five years. With a score of over 3,000, Tony of Pennington was unaware of the danger that he was in.

Should I worry about a high calcium score? ›

Scores between 100 and 300 indicate more calcium in your arteries and a higher risk of heart attack. Scores above 300 suggest you are at a high risk of a heart attack and require prompt treatment.

Can you have a calcium score of 2000? ›

Conclusion. The Agatston calcium score of >2000 was reported in 1% of 44 052 asymptomatic persons referred for non-enhanced CCT for the assessment of subclinical atherosclerosis. The frequency of CCT angiographic stenoses was 87% among symptomatic patients with calcium score ≥400.

When do you repeat coronary calcium score? ›

If you do a calcium score, and your patient's score is zero, then you can repeat the calcium scoring in about five years or so. If the score is less than 25th percentile, then the patient clearly needs risk factor modification and primary prevention strategy may need to see a cardiologist.

What is the best test to check for clogged arteries? ›

A CT coronary angiogram can reveal plaque buildup and identify blockages in the arteries, which can lead to a heart attack. Prior to the test, a contrast dye is injected into the arm to make the arteries more visible. The test typically takes 30 minutes to complete.

How long can you live with coronary artery calcification? ›

As follow-up lengthened, all-cause mortality rates increased: Patients with a CAC score of 0 had a mortality rate of 0.7% at 7 years (11). The incident mortality curves revealed very low mortality through 5 years, but mortality seemed to increase substantively between 5 and 15 years of follow-up.

What is the normal range for calcium score? ›

In our bodies, calcium is a mineral that makes up our bones, as well as a salt that dissolves in our blood and regulates bodily function. At UCLA, the normal range for blood calcium level is 8.6 to 10.3 mg/dL. In order to maintain a normal calcium level, the body uses hormones to regulate blood calcium levels.

What does a calcium score of 2000 mean? ›

A calcium score of 0 means there is no calcified plaque in the arteries. A calcium score of 1-10 means minimal plaque. A calcium score of 11-100 means mild plaque. A calcium score of 101-400 means moderate plaque. A calcium score of >400 means severe plaque.

What is a high calcium score? ›

Scores from 1 to 100 indicate a low or medium risk of a heart attack. Scores between 100 and 300 indicate more calcium in your arteries and a higher risk of heart attack. Scores above 300 suggest you are at a high risk of a heart attack and require prompt treatment.

What is a good CT calcium score? ›

Who interprets the results and how do I get them?
Calcium ScorePresence of CAD
1-10Minimal evidence of CAD
11-100Mild evidence of CAD
101-400Moderate evidence of CAD
Over 400Extensive evidence of CAD
1 more row


1. All About the Calcium Score | Heart Scan
(Heart Matters)
2. Coronary Calcium-Score Test for Heart Risk
(Cleveland Clinic)
3. What is a Coronary Calcium Score?
(Princeton Longevity Center)
4. ARA's Dr. Lieberman explains a CT calcium scoring
(ARA Diagnostic Imaging)
5. Coronary Calcium Scores: Determining Your Risk to Start Preventive Therapy
6. Can I Lower My Coronary Artery Calcium Score? Dr. Paul Jurgens from South Denver Cardiology
(South Denver Cardiology Associates, P.C.)

Top Articles

You might also like

Latest Posts

Article information

Author: Stevie Stamm

Last Updated: 11/30/2022

Views: 5809

Rating: 5 / 5 (80 voted)

Reviews: 95% of readers found this page helpful

Author information

Name: Stevie Stamm

Birthday: 1996-06-22

Address: Apt. 419 4200 Sipes Estate, East Delmerview, WY 05617

Phone: +342332224300

Job: Future Advertising Analyst

Hobby: Leather crafting, Puzzles, Leather crafting, scrapbook, Urban exploration, Cabaret, Skateboarding

Introduction: My name is Stevie Stamm, I am a colorful, sparkling, splendid, vast, open, hilarious, tender person who loves writing and wants to share my knowledge and understanding with you.