There are situations when your bad cholesterol levels or LDH can be consistently high during your blood tests, yet, your cardiovascular disease risk is moderate. In this situation, what should you do?

You and your doctor may determine what course of action is best by performing a cardiac CT scan, commonly known as a coronary artery calcium test (CAC), and receiving a calcium score.

This article provides information regarding the benefits and drawbacks of CAC testing and calcium scoring that help you make an informed decision about whether or not to have this procedure done to assess your risk of cardiovascular disease and cardiovascular events.

Understanding coronary artery calcium testing and calcium scoring

Guidelines for cholesterol control include the CAC test and calcium scoring, developed by the American College of Cardiology (ACC). The screening test results can give you an idea of how likely you are to suffer a heart attack. It can also classify those at intermediate risk for cardiovascular disease into either high- or low-risk categories.

The examination itself only requires about 15 minutes and causes no discomfort. CT scans, which are low-dose X-rays, can detect hardened or “calcified” plaque in the coronary arteries. Your heart muscle relies on the blood flow provided by your coronary arteries. After that, doctors assess the degree of calcified plaque by measuring it and assigning it a score.

What’s Calcium Scoring?

The CAC scan will determine your calcium level and give you a score. The possible range of the score is from 0-400 and up. Here’s what the numbers mean:

  • 0:  Plaque is absent, so your chances of having a heart attack are minimal.
  • 1 to 10: Plaque has formed in very modest amounts. You have a modest risk of heart disease and a 10% probability of developing heart disease.
  • 11 to 100: There is evidence of plaque. You have a moderate risk for a heart attack due to your mild heart condition.
  • 101 to 400: There is a noticeable amount of plaque. Plaque may be clogging an artery, leading to heart disease. In all likelihood, you will suffer a heart attack sometime soon.
  • Above 400: There is a substantial amount of plaque present. The risk of having a heart disease, especially a heart attack, is high, and there is a better than 90% probability that plaque is closing off an artery in your body.

Who Needs to Get a Calcium Score for the Heart?

A calcium score test is not a replacement for more conventional risk assessment methods that consider things like blood pressure, smoking, and LDL cholesterol, amongst other risks of heart disease factors.  

Nonetheless, a CAC test can aid you and your doctor’s decision as to whether or not your risk of coronary attack is sufficiently high to require cholesterol-lowering medicine. Medication such as statins could be part of such a treatment plan.

Image alt text: calcium supplement tablets with vitamin D to improve calcium score.

Author credit: By Ragesoss – Own work, CC BY-SA 4.0,

However, it can be challenging to decide if the danger is moderate. For instance, if the arteries are spotless, starting a statin is unnecessary. A healthcare physician may take a specialized approach in this situation, one that considers your calcium levels or particular risk factors.

Do I Need to Get a CAC Test?

Previously, doctors didn’t order calcium scores for healthy 20- to 30-year-olds. In such a low-risk demographic, calcified plaque is quite rare. However, a non-zero CAC score, according to one study, is associated with a significantly increased risk of cardiovascular disease and death in young adults compared to people of other ages.

Those between the ages of 20 and 39 can reduce their risk of cardiovascular disease and heart attack by adopting a heart-healthy lifestyle. You must, therefore:

  • Exercising regularly
  • Manage your stress and anxiety
  • Eat healthy diet
  • Quit smoking and limit your alcohol intake
  • Get enough sleep
  • Keep a healthy weight

Patients at high risk may also not be good candidates for a CAC test. Statins or antidepressants and other preventative therapies, such as lifestyle adjustments, are recommended by guidelines for this population to reduce the risk of cardiovascular problems.

What’s the point of taking a calcium score test?

Initially, the doctor would estimate your risk of heart disease using data from your demographics, family medical history, current health status, lifestyle choices, and laboratory tests.

Some of these tests are not a reliable predictor of who will develop crystallized plaque and who will not, and they don’t measure the correct amount of plaque damage in your arteries. Taking people from different typical risk groups and testing them for CAC yields some unexpected findings.

The calcium score is a good indicator of heart health because:

Calcium score predicts non-cardiovascular death

Clinically, calcium scoring helps in determining the likelihood of developing cardiovascular disease. Cancer, kidney illness, and gastrointestinal issues are only a few of the many particular causes of death that are studied. Clinically, calcium scoring helps in determining the likelihood of developing cardiovascular disease. Cancer, kidney illness, and gastrointestinal issues are only a few of the many particular causes of death that are studied.

Calculating arterial age with the calcium score helps avoid micro- and macro-vascular problems. Besides, the research found that over 68% of those with newly diagnosed cancer had more calcium deposits in their blood. Some studies also found a 70% correlation between excessive calcium levels and the onset of kidney illness.

Offers more actionable insights than competing tests.

Scores based on calcium levels are used with the Framingham risk score and other tests to provide a more precise risk classification. This imaging test can significantly strengthen other diagnostic procedures like:

  • Carotid intima-media thickness
  • Stress myocardial perfusion
  • C-reactive protein levels

Helps Avoid Unnecessary Medical Procedures

Calcium score assessment before invasive examinations could help patients with unusual clinical symptoms. If the test returns normal, you can put off more expensive intrusive testing, making it a win-win.

It’s a reliable marker of coronary atherosclerosis

The American Heart Association recommends calcium scoring for people with moderate risks. According to the American Heart Association, low-, moderate-, and high-risk patients can all benefit from calcium scoring.

When used with demographic information and the overall burden of disease, calcium scoring provides an accurate assessment of an individual’s risk for cardiovascular disease. It’s not just a way to get a risk score but also a technique for figuring out what to do about a situation and what to address.

Yields a more precise prediction amongst asymptomatic individuals

Studies have shown that the calcium scoring test is practical even in asymptomatic people. It delivers a more accurate estimate of the risk of a heart attack when applied to asymptomatic individuals.

The calcium score has a practical value from an economic standpoint

Testing for calcium scores can prevent serious medical problems and expensive hospital stays. Since calcium scoring is reliable, asymptomatic people whose initial tests were normal may not need additional monitoring.

Nonetheless, the test may be required more frequently for those in high-risk groups, including smokers, diabetics, and the elderly. In addition, early assessment with calcium scoring allows patients to take preventative measures and put off costly procedures.

How can CAC testing put patients at risk?

Testing for CAC carries with it several potential dangers, including:

Risks of Radiation Exposure: When getting a computed tomography scan, you risk being exposed to radiation. There won’t be much radiation exposure. Yet, frequent scans raise concerns about exposure.

False or unreal comfort: Even if a young adult scores 0, they may have a substantial volume of non-calcified plaque. So, it is all the more imperative that people choose healthy habits.

False conclusions: Despite the absence of overt arterial disease, an increased calcium score may be present. Those at little risk of heart disease are more likely to receive false positive results.

Psychological repercussions: Studies have found that reclassification as a high-risk group may cause emotional distress for certain people.

There’s also a potential that the scan will pick up on “incidental findings,” or things that weren’t part of the original plan but turned up during the examination. Incidental discoveries may necessitate further scans or procedures based on the nature of the complications.


Care professionals can use your calcium score, which results from CAC testing, to gauge your risk of developing heart disease. A patient’s calcium score may reflect the effectiveness of preventative medications such as statins and lifestyle adjustments in reducing the risk of cardiovascular problems.

However, CAC testing should not be used in place of more traditional diagnostic procedures for cardiovascular disease, such as a lipid panel that evaluates your cholesterol. If you are concerned about your risk for heart disease or want to know what tests would be most helpful, it is best to speak with a doctor.