From the Guidelines
For a patient with a coronary calcium score of 175, treatment typically includes moderate to high-intensity statin therapy along with lifestyle modifications. This score falls in the moderate risk category (75-300), indicating the presence of atherosclerotic plaque and an elevated risk for cardiovascular events compared to age-matched individuals 1. According to the 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol, a coronary calcium score of 100 or higher is an indication for statin therapy 1.
Key Components of Treatment
- Moderate to high-intensity statin therapy, such as atorvastatin 20-40 mg daily or rosuvastatin 10-20 mg daily
- Lifestyle modifications, including:
- A heart-healthy diet low in saturated fats
- Regular physical activity (at least 150 minutes of moderate-intensity exercise weekly)
- Smoking cessation if applicable
- Maintaining a healthy weight
- Blood pressure control to below 130/80 mmHg
- Diabetes management if present
- Consideration of aspirin therapy (81 mg daily) for select patients with additional risk factors, individualized based on bleeding risk
Monitoring and Follow-Up
Regular follow-up with a healthcare provider is recommended to monitor lipid levels, with a target LDL cholesterol below 70 mg/dL 1. The goal of this comprehensive approach is to stabilize existing plaque, prevent further progression of coronary artery disease, and reduce the risk of future cardiac events by addressing the underlying atherosclerotic process that the calcium score has identified.
From the Research
Treatment Guidelines for Coronary Calcium Score of 175
The treatment guidelines for a patient with a coronary calcium score of 175 are based on the assessment of their risk for atherosclerotic cardiovascular disease (ASCVD).
- The 2018 American Heart Association/American College of Cardiology Guideline on the Management of Blood Cholesterol recommends the use of risk-enhancing factor assessment and the selective use of coronary artery calcium (CAC) scoring to guide the allocation of statin therapy among individuals with an intermediate risk of ASCVD 2.
- A coronary calcium score of 175 indicates a moderate to high risk of ASCVD, and the decision to initiate or intensify statin therapy may be uncertain across a broad range of estimated 10-year ASCVD risk of 5% to 20% 3.
- CAC testing can reclassify risk upward or downward in approximately 50% of this group to inform the risk discussion, and the use of CAC scoring is associated with significant improvements in the reclassification and discrimination of incident ASCVD 2.
Risk Assessment and Management
- The clinical significance of the coronary artery calcium score (CACS) has been discussed since Agatston et al. first reported its utility in 1990, and CACS is less invasive and less expensive than contrast-enhanced coronary computed tomography (CT) angiography 4.
- A CACS of 175 is considered moderate to high risk, and management using statin therapy may be beneficial, although the prognostic significance of patients with moderate CACS (1-400) is still uncertain 4.
- The combination of CACS and noninvasive cardiac imaging may be useful in assessing the risk of ASCVD and guiding treatment decisions 4.
Aspirin Therapy
- Higher CAC categories (CAC 1-99 and ≥100 vs CAC 0) are associated with both ASCVD and bleeding events, but the association between CAC and bleeding is attenuated after multivariable adjustment 5.
- A high CAC score identifies individuals who would experience net benefit from primary prevention aspirin therapy, but only in the setting of lower bleeding risk and estimated ASCVD risk that is not low 5.