From the Guidelines
A coronary calcium score of 90 indicates moderate coronary artery calcification and suggests an increased risk for cardiovascular events, thus management should focus on aggressive risk factor modification, including the initiation of statin therapy, as recommended by the 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease 1 and the 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol 1.
Lifestyle Modifications
The patient should start with lifestyle changes including:
- A heart-healthy diet (Mediterranean or DASH diet)
- Regular aerobic exercise (150 minutes weekly)
- Smoking cessation
- Weight management
Medication Therapy
Medication therapy typically includes:
- A moderate-intensity statin such as atorvastatin 20mg daily or rosuvastatin 10mg daily to lower LDL cholesterol below 70 mg/dL, as supported by the 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol 1
- Consider aspirin 81mg daily if the patient has additional risk factors and low bleeding risk
- Blood pressure should be controlled to less than 130/80 mmHg using appropriate antihypertensives if needed
- For patients with diabetes, maintain tight glycemic control with a target HbA1c below 7%
Follow-up and Further Testing
Regular follow-up with a primary care physician or cardiologist is recommended every 3-6 months to monitor medication effectiveness and adjust therapy as needed. Further cardiac testing such as stress testing may be warranted based on symptoms or risk profile, as suggested by the 2019 ESC guidelines for the diagnosis and management of chronic coronary syndromes 1.
Comprehensive Approach
This comprehensive approach addresses the underlying atherosclerotic process that causes coronary calcification and helps prevent progression to symptomatic coronary artery disease. The European Heart Journal guidelines also emphasize the importance of lifestyle changes and evidence-based prescriptions to increase adherence to treatment 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Management of Severe Coronary Artery Calcification
The management of a patient with a coronary calcium score of 90, indicating severe coronary artery calcification, involves several key considerations:
- Risk Assessment: The coronary artery calcium score is a significant predictor of cardiovascular risk, and a score of 90 indicates a high risk of cardiovascular events 2.
- Statin Therapy: High-intensity statin therapy is recommended for patients with severe coronary artery calcification, as it has been shown to reduce the risk of cardiovascular events 3.
- Lifestyle Modifications: Patients with severe coronary artery calcification should also be encouraged to make lifestyle modifications, such as increasing exercise and making dietary changes, to reduce their cardiovascular risk 4.
- Aspirin Therapy: Aspirin therapy may also be considered for patients with severe coronary artery calcification, although the decision to initiate aspirin therapy should be made on an individual basis 4.
- Monitoring and Follow-up: Regular monitoring and follow-up are essential to assess the effectiveness of treatment and make any necessary adjustments to the patient's management plan.
Treatment Options
The treatment options for a patient with a coronary calcium score of 90 include:
- High-Intensity Statin Therapy: High-intensity statin therapy, such as atorvastatin 20-40 mg daily, to reduce low-density lipoprotein cholesterol levels and slow the progression of coronary artery calcification 5, 3.
- Lifestyle Modifications: Lifestyle modifications, such as increasing exercise and making dietary changes, to reduce cardiovascular risk 4.
- Aspirin Therapy: Aspirin therapy, 81-100 mg daily, to reduce the risk of cardiovascular events 4.
- Other Therapies: Other therapies, such as ezetimibe or proprotein convertase subtilisin/kexin type 9 inhibitors, may also be considered for patients with severe coronary artery calcification and high cardiovascular risk 3.