Risks and Benefits of Coronary Calcium Test

As you know, calcium is essential for healthy teeth, bones, and other body parts. But, what few people realize is that calcium can be extremely dangerous when we’re talking heart health?

Under normal circumstances, your body makes good use of calcium fortifying your bones and keeping them strong. What you may not know is that your blood vessels also use calcium to help move blood throughout the body. But, when this calcium from the blood vessels is trapped in plaque in your heart, we call it coronary calcium. And this can become a pretty dangerous situation.

How does coronary calcium make plaque worse?

Plaque starts to build up in weak spots where the lining of your arteries has been damaged. High blood pressure is a big risk factor, but genetics, family history of heart disease, unhealthy lifestyle and diet are all risk factors for arterial damage.

Arterial plaques are a sticky combination of cholesterol, fats, cellular waste, calcium, and a clot-making substance called fibrin. They start out soft and “waxy,” but as calcium in the blood stream finds its way to these waxy deposits, they harden in place over time.

The result? Narrowing of the arteries. To which your heart responds by pumping harder, which puts pressure on the plaque site, which can eventually burst.

When this happens, your body sends blood cells called platelets to the site of the “explosion”. The platelets are just doing their job, sealing off the site by clumping together to form blood clots. But the clots they form narrow the arteries even more, limiting the flow of oxygen-rich blood through your body.

No need to say how much we don’t want that.

What is the coronary calcium test?

The test scans your heart and arteries with a special type of X-ray device called a CT scan. You may have heard other names for the procedure:

They’re all the same, taking a series of pictures that can spot hardened plaque in your arteries in its earliest stages, giving you and your doctor a running start in determining and implementing interventions that can considerably lower the risks it presents.

Because calcium usually starts to accumulate on plaque sites long before significant blockages develop, the coronary calcium test can detect coronary artery disease very easily and very early—well before a stress test could signal a problem.

What your score means

Your test score indicates your risk of heart attack or stroke over the next decade. It’s expressed as an assessed risk of cardiac trouble during that time, that is, you have a 1, 5, 10, 20, etc. up to a 100 percent chance. A good score on a cardiac calcium test is a good indicator that you won’t see heart trouble over the next 10 years. A high score signals trouble.

Who should get the test?

Your first step in deciding whether the test is for you is to assess how likely you are to get heart disease. You and your doctor will base that decision on:

  • Your age
  • Your blood pressure
  • Your cholesterol level
  • Whether you smoke
  • Your gender
  • Family history of heart disease or cardiac events

Some doctors recommend all males over 45 and all menopausal women take the test, but one time only. But most agree that the scan is most useful to assess patients at moderate risk of heart disease, as well as those whose risk is uncertain.

A positive scan can help give you and your doctor the information you need to lower your risk.

If you have only a low risk, the test probably will not show any calcified plaque—there’s no reason to expose yourself to the radiation required to do the test.

If you’re a high-risk patient, you have a high risk of heart disease or stroke, so your doctors should already be working with you to make lifestyle changes or take medication to benefit your heart. A test showing plaque wouldn’t prompt more or different treatment.

What do doctors recommend?

Various experts cite concerns about the test’s value.

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First and foremost, measuring coronary calcium is by no means a 100 percent reliable indicator of risk. The scan measures plaque that’s already hardened and fixed in place.

But the very significant presence of soft plaque? Not measured. This is a risk factor—soft plaque can break free of arteries and roam at will through the circulation system until it stalls against a blockage too narrow to pass through. That’s a heart attack or stroke waiting to happen.

So even someone with no coronary plaque, but with undetected soft plaque, could still run into trouble later in life.

Another caution—a low cardiac calcium score is seen by some people to be a get-out of-danger-free card. No cardiac calcium? No need to change my ways—I’ll have another whiskey and a smoke.

Far from the truth. Bad habits remain bad habits. If you brush off known cardiac risk factors—high cholesterol and blood pressure, smoking, unhealthy diet, and a sedentary lifestyle, you pay a price.

“It’s not a ticket to be reckless, but it can help reduce a person’s anxiety about their risk of a heart attack,” says one expert. “The calcium score is a risk assessment tool, helpful in tailoring medical therapy, diet and exercise.”

To test or not to test?

The risk factors doctors watch for in their patients include a lot of so-called “non-medical” assessments. And that’s fine. Docs don’t need more data than they already have to know that readily observable, unhealthy lifestyles and diet skip hand in hand down the road to every disease.

But when findings on a calcium scan are combined with the presence of these traditional risk factors, we get a much clearer picture of a person’s risk of suffering a heart attack in the next decade. And if the calcium score is zero, it might mean the person won’t be prescribed one of many unneeded heart-protective medications, which often have undesirable side effects. A good result!

If these assessments can be sharpened, they certainly should be. Not least to help prevent under-or overestimating the risk of heart disease, and under-or overprescribing drugs.

Finally, if the scan does find calcium deposits, it can be an excellent motivator for some people to make healthy lifestyle changes.

Indeed, this was the case in an analysis of six studies involving 11,000 patients. Those told they had coronary calcium were two to three times more likely than those with zero calcium to start taking steps to lower cholesterol or blood pressure, and to take up heart-healthy behaviors like quitting smoking or exercising more.

Food for health

Of course, top on the list of heart-healthy behaviors is a healthy diet. If you’re eating too much sugary, salty, artificially flavored, chemically noxious, Standard American Diet fare, you’re hurting yourself. Go fresh, local organic, low-carb and get healthier with that alone. Include these artery-cleansing foods:

  • Asparagus
  • Avocado
  • Broccoli
  • Fatty Fish
  • Nuts
  • Olive Oil
  • Watermelon
  • Turmeric

Good quality supplements can both prevent and reverse plaque buildup in arteries:

  • A good daily multivitamin/multimineral nutritional supplement
  • 75–150 mg of CoQ10 with enhanced bioavailability
  • 400–800 mg of magnesium
  • 1–2 g of fish or squid oil for omega-3 fatty acids
  • 2–3 ounces of pomegranate juice daily
  • 1 cup of organic green tea a day
  • 500–1,000 mg of L-carnitine.

I urge you to take this healthy dietary path regardless of your health status, but especially if you’re at moderate risk of heart attack or stroke.

As for the coronary calcium test, as I mentioned, some physicians keep it simple: it’s a one-time “yes” to the test for all men older than 45, and all menopausal women.

In the end, as always, you and your doctors are the best decision makers.

Take good care.



Last Updated: August 16, 2018
Originally Published: July 19, 2018