From the Guidelines
A calcium score of 40 indicates mild coronary artery calcification, suggesting early stages of coronary artery disease, and according to the most recent guidelines 1, a score of 1-99 favors statin therapy, especially after age 55. You should discuss this result with your doctor, who may recommend lifestyle modifications including a heart-healthy diet low in saturated fats, regular exercise (aim for 150 minutes of moderate activity weekly), smoking cessation if applicable, and maintaining healthy weight. Medication may include low-dose aspirin (81mg daily) and statins like atorvastatin (10-20mg daily) or rosuvastatin (5-10mg daily) to lower cholesterol, especially if you have other risk factors. Your doctor might also recommend controlling blood pressure with medications if needed. This score warrants attention but isn't severely elevated; calcium deposits in coronary arteries indicate atherosclerosis (plaque buildup), which can eventually restrict blood flow to the heart. Regular follow-up with your physician, typically annual check-ups with lipid panels and blood pressure monitoring, is important to track progression and adjust treatment as needed. The goal is to prevent further plaque development and reduce your risk of future cardiac events, as supported by various global coronary artery calcium guidelines 1. Key considerations include:
- The National Lipid Association (NLA) recommends CAC scoring to guide preventive strategies for ASCVD risk reduction 1.
- The Society of Cardiovascular Computed Tomography (SCCT) endorses CAC screening for asymptomatic individuals without clinical ASCVD, particularly those at intermediate risk 1.
- The American Association of Clinical Endocrinology emphasizes CAC measurement's high predictive value and utility in refining risk stratification to determine the need for more aggressive treatment strategies 1. Given the evidence, it is crucial to follow the guidelines and discuss the appropriate course of action with your doctor, considering your individual risk factors and medical history.
From the Research
Calcium Score Interpretation
- A coronary artery calcium (CAC) score of 40 indicates the presence of coronary atherosclerosis, as stated in the study 2.
- This score can be used to assess the risk of major cardiovascular outcomes, especially in asymptomatic individuals, and can inform primary prevention interventions such as statins and aspirin 2.
Risk Assessment
- A CAC score of 40 falls into the category of CAC > 0, which is associated with an increased risk of major adverse cardiovascular and cerebrovascular events (MACE) compared to a CAC = 0 in asymptomatic populations 3.
- The risk of MACE is higher in individuals with CAC > 0, with a pooled risk ratio (RR) of 4.05 (95% CI 2.91-5.63, P < 0.00001) in asymptomatic populations 3.
Aspirin Therapy
- The use of aspirin for primary prevention of atherosclerotic cardiovascular disease (ASCVD) is a topic of ongoing debate, with some studies suggesting a reduction in ASCVD events but an increase in bleeding risk 4, 5.
- A study found that a high CAC score (≥100) identifies individuals who may derive net benefit from primary prevention aspirin therapy, but only in those with lower bleeding risk and estimated ASCVD risk that is not low 5.
- However, another study found that aspirin's treatment effect does not increase as ASCVD risk increases, and that the use of aspirin for higher-risk primary prevention patients is not beneficial 4.
Considerations
- The decision to use aspirin for primary prevention of ASCVD should be made on an individual basis, taking into account the patient's CAC score, bleeding risk, and estimated ASCVD risk 5, 6.
- Further studies are needed to provide more definitive guidance on the use of aspirin in individuals with elevated CAC scores and ASCVD risk 6.