Cardiologist, author, and heart health expert Dr. Sarah Samaan offers advice on how to live a heart smart life.See all posts »
What Does it Mean if Your Coronary Calcium Score Rises?
One of my first postings last year addressed the coronary calcium score, a quick CT-scan test that can discover heart disease in its very earliest stages. It is called a coronary calcium score because the test detects calcifications (calcium deposits) in the coronary (heart) arteries. Calcifications occur when cholesterol plaque is present. The older the plaque, the more likely it is to calcify, or harden. Sometimes this is referred to as “hardening of the arteries.” Atherosclerosis is the medical term that we physicians use for this process.
If you have a calcium score of zero, the chances are good that you have no plaque. However, a small percent of people will have cholesterol plaque that is not calcified, so the test is not perfect. In addition, if there is calcified plaque in the arteries, there is probably softer, newer, noncalcified plaque as well. This is important, because this is the plaque that we may are most likely to shrink or stabilize with a combination of lifestyle, diet, exercise, and medical therapy.
We usually don’t repeat calcium scores more than every three to five years. In fact, one can make a good argument for not repeating the test at all if the first result is abnormal, since it may not make a difference in our medical or lifestyle recommendations. Nevertheless, as the test is becoming more available, many people do have serial testing.
Although we would like to think that we can reduce a calcium score, this is usually not feasible, since we can think of the hardened and calcified plaque almost as a scar. What is most important is stabilizing that plaque and preventing it from getting worse. That’s where the confusion comes in.
In most cases, calcium scores will increase over time. This is probably because the softer plaque not visible on the initial scan eventually hardens, becoming calcified. We are able to shrink plaque with statin drugs and serious lifestyle changes, but the rate of shrinkage is very slow.
A study published in 2010 by Dr. Victor Goh and colleagues in the journal Cardiovascular Ultrasound helps us to better understand how medical therapy and lifestyle can impact an initially abnormal calcium score. One hundred and thirteen men and women with very high scores were followed with serial calcium scores for about 10 years. Their cholesterol levels were treated aggressively with drug therapy, and they were counseled on the importance of a heart healthy lifestyle, including diet, weight loss, exercise, and not smoking.
While previous studies have shown a 33 percent annual increase in coronary calcification in the average individual, those in this study progressed by only 24 percent annually. Even more importantly, when lifestyle changes were consistent and medications were taken as prescribed, progression was only 16 percent per year. Twenty percent were actually able to lower their scores.
The take home message? If your calcium score rises, don’t be discouraged. It doesn’t necessarily mean that you are doing something wrong, or that your medication isn’t working. By choosing a healthy lifestyle and taking medications when needed, you can make an important impact on your heart health both now and for the future.
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