From the Guidelines
A coronary calcium score of 5.6 indicates minimal calcification in your coronary arteries and a very low risk for coronary artery disease, and thus, aggressive medical therapy is not typically warranted, but focusing on preventive measures is recommended. At this level, the risk of coronary artery disease is very low, and the focus should be on maintaining a heart-healthy lifestyle, including:
- Regular exercise, aiming for 150 minutes of moderate activity weekly
- A Mediterranean or DASH diet rich in fruits, vegetables, whole grains, and lean proteins
- Avoiding smoking
- Regular monitoring of blood pressure, targeting <130/80 mmHg, cholesterol levels, targeting LDL <100 mg/dL, and blood glucose 1. While statin therapy is not automatically indicated at this score level, it may be considered based on other risk factors such as family history, diabetes, or elevated LDL cholesterol 1. A follow-up calcium score in 3-5 years may be appropriate to monitor for progression, as this minimal calcium score suggests early atherosclerosis, and lifestyle modifications now can significantly slow or prevent disease progression, potentially avoiding future cardiac events 1.
From the Research
Cardiology Recommendations for a Total CT Coronary Calcium Score of 5.6
- A total CT coronary calcium score of 5.6 is considered low, indicating a relatively low risk of atherosclerotic cardiovascular disease (ASCVD) 2, 3.
- The American College of Cardiology and the American Heart Association guidelines recommend treatment of patients with severe hypercholesterolemia with a high-intensity statin, but coronary artery calcium (CAC) scoring may be used to clarify risk in this population 4.
- CAC scoring has been validated as a well-established screening method for cardiovascular risk stratification and treatment management, and can be used to guide shared decision making in patients with intermediate-risk ASCVD 2, 3.
- Statin therapy may not decrease CAC, and may even increase existing calcification or its density, but CAC scoring retains robust risk prediction in statin users 5, 6.
Risk Stratification and Treatment
- A CAC score of 5.6 would likely be classified as low-risk, and may not necessitate immediate initiation of statin therapy 2, 4.
- However, other risk factors such as age, male gender, smoking, diabetes, systolic blood pressure, and obesity should also be taken into account when determining the overall risk of ASCVD 4.
- The decision to initiate or intensify statin therapy should be based on a comprehensive risk assessment, including CAC scoring, and should involve shared decision making between the patient and clinician 2, 3.
Monitoring and Follow-up
- Regular monitoring of CAC scores and other risk factors may be necessary to assess the progression of atherosclerosis and adjust treatment accordingly 5, 6.
- CAC scoring can be used to evaluate the effectiveness of statin therapy and other treatments, and to guide adjustments to treatment plans as needed 3, 4.