From the Guidelines
A coronary calcium score of 422 is considered high and indicates significant calcified plaque buildup in your coronary arteries, suggesting a high risk for coronary artery disease and future cardiac events. This score falls into the "severe" category (scores above 400) and is associated with an increased risk of incident coronary heart disease (CHD) events over the ensuing 3 to 5 years 1. According to the 2021 update of the ACR Appropriateness Criteria, a CAC score of 401 to 1,000 is associated with an adjusted relative risk of 2.5 for death, and a score above 1,000 is associated with an adjusted relative risk of 4 for death 1.
The management of a high coronary calcium score typically includes medications like statins to lower cholesterol, aspirin for prevention, and possibly blood pressure medications. Lifestyle modifications are essential, including:
- A heart-healthy diet low in saturated fats
- Regular exercise (aim for 150 minutes of moderate activity weekly)
- Smoking cessation if applicable
- Stress management
This score doesn't necessarily mean you'll have a heart attack soon, but it does indicate that atherosclerosis (hardening of the arteries) is present and requires attention. The calcium score measures calcified plaque only, so additional testing like a stress test or coronary angiogram might be recommended to assess for non-calcified plaque and determine if any blockages are causing reduced blood flow to your heart. The 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease suggests that coronary artery calcium measurement can be a useful tool in refining risk assessment for preventive interventions, such as statin therapy, in individuals with intermediate predicted risk or select adults with borderline predicted risk 1.
It is recommended to consult with a cardiologist promptly to discuss treatment options and develop a personalized plan to reduce the risk of future cardiac events. The absence of coronary artery calcium does not rule out noncalcified plaque, and clinical judgment about risk should prevail 1. Recent data from MESA suggest similar effects of CAC visualization on lipid-lowering and aspirin therapy, and the use of statin and aspirin was independently associated with a significantly higher likelihood of use in those with any coronary calcium over 6 years 1.
From the Research
Coronary Calcium Score Interpretation
A coronary calcium score of 422 indicates a significant amount of calcium buildup in the coronary arteries. This score is associated with an increased risk of cardiovascular events and mortality.
Risk Assessment
- The presence of a high coronary calcium score, such as 422, is a strong indicator of atherosclerosis and coronary artery disease 2.
- Studies have shown that a coronary calcium score greater than 100 is associated with a higher risk of cardiovascular events and mortality, especially in younger adults 3.
- A score of 422 would be considered high-risk, and individuals with this score may be more likely to experience cardiovascular events, such as heart attacks or strokes.
Comparison to Other Scores
- A coronary calcium score of 0 is associated with a low risk of cardiovascular events, while a score greater than 0 is associated with an increased risk 2.
- Scores between 1-100 may carry an increased risk of cardiovascular events, but not necessarily mortality 3.
- Scores greater than 100, such as 422, are associated with a higher risk of both cardiovascular events and mortality 3.
Clinical Implications
- Individuals with a high coronary calcium score, such as 422, may benefit from aggressive management of cardiovascular risk factors, such as high blood pressure, high cholesterol, and diabetes 4.
- Statin therapy and other lipid-lowering treatments may be recommended to reduce the risk of cardiovascular events 5.
- Lifestyle modifications, such as a healthy diet and regular exercise, may also be recommended to reduce cardiovascular risk.