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Heart Smart Living
Heart Smart Living

Cardiologist, author, and heart health expert Dr. Sarah Samaan offers advice on how to live a heart smart life.

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Your Coronary Calcium Score: What it Is, What it Means

CT Scan of the Chest, showing the Heart
CT Scan of the Chest
Our understanding of coronary artery disease has evolved tremendously over the past two decades. We now know that heart disease is not just something that shows up in middle age or later, but rather a process that can begin as early as the teenage years. It used to be that the only non-invasive way we had to detect heart disease was a treadmill stress test. Unfortunately, that test will only pick up blockages that are severe enough to limit blood flow, meaning at least a 70 percent narrowing of a coronary artery.

The Coronary Calcium Score (CCS) is a much newer test that uses a computerised tomography (CT) scanner to detect heart disease in its earliest stages. Most cholesterol plaque becomes hardened, or calcified, over time. The CCS test detects these calcifications in the walls of the heart arteries, and thus allows us to see cholesterol buildup well before it has grown large enough to cause a blockage. The amount of calcification is measured by a computer program, resulting in a score that gives us a good idea of the amount of plaque in a person’s heart.

What the CCS does not do is to tell us whether or not there is a blockage. For instance, it is possible to have plaque layered throughout all the heart arteries, resulting in a very high score, but without any major blockage. Conversely, I have seen people with fairly modest scores whose plaque is all lumped up in one small area, severely limiting blood flow.  On rare occasion, I have had patients with a major blockage who had a score of zero, because they had plaque that was not calcified. That is why the CCS is often used in conjunction with a stress test.

The downside to the CCS is the radiation dose. Depending on the equipment and protocol used at the testing center, you may receive as little as two mammograms worth of radiation, or as much as 100 chest x-rays. It makes sense to ask for this information before going ahead with the study.

The best thing about the CCS is that it allows us to take preventive action early, with the hope that we can reduce the risk for heart attacks later in life. This may help your doctor decide whether to prescribe medical therapy, lifestyle changes, or, more often, both.

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Tags: Heart Procedures and Surgery , You and Your Doctor

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About the Author


Dr. Samaan is an acclaimed cardiologist, writer, and heart health educator.