Is a Coronary Calcium Score of 220 Considered High?
A coronary artery calcium score of 220 is considered moderately elevated and places you at increased cardiovascular risk, falling into the category that warrants aggressive risk factor modification and likely statin therapy. 1
Risk Stratification Context
Your score of 220 falls into the 101-400 range, which represents moderate coronary atherosclerosis burden. 1 To understand the significance:
- CACS 0: Excellent prognosis, <1% annual risk for cardiac events 1
- CACS 1-100: Mild atherosclerosis, low-moderate risk 1
- CACS 101-400: Moderate atherosclerosis, intermediate-high risk (your category) 1
- CACS 401-1000: Extensive atherosclerosis, high risk 1
- CACS >1000: Very high risk, approaching secondary prevention event rates 2
What This Score Means Clinically
Your score indicates definite coronary atherosclerosis and represents approximately 20% of your total atherosclerotic plaque burden, as not all plaques are calcified. 1, 3 The cardiovascular risk increases proportionally with calcium scores, and studies show:
- A 7-fold increase in risk for cardiovascular events when comparing CACS >100 vs. CACS = 0 1
- Relative risk of 2.7-4.1 times higher for hard coronary events in the 101-400 range compared to zero calcium 1
- Your vascular age is likely significantly higher than your chronological age—a CACS of 100 corresponds to approximately 73 years of arterial age 1
Recommended Management Approach
Moderate-to-high intensity statin therapy is recommended for patients with CACS >100, regardless of other traditional risk factors. 4 The number needed to treat is 30 to prevent one cardiovascular event over 5 years with statin therapy at this score level. 4
Specific Actions Required:
- Initiate statin therapy (moderate-to-high intensity) if not already on one 4
- Target blood pressure <130/80 mmHg 4
- Optimize LDL-cholesterol based on overall risk profile 4
- Implement lifestyle modifications: 150 minutes weekly moderate-intensity exercise, Mediterranean or DASH diet, smoking cessation if applicable, weight management 4
Important Caveats
This score indicates atherosclerosis burden but does NOT reliably predict obstructive coronary disease. 1, 3 The specificity for predicting ≥50% stenosis is only approximately 50%. 1, 3 Your score proves coronary atherosclerosis exists but doesn't necessarily mean you have flow-limiting blockages requiring intervention. 1
If you are asymptomatic, invasive testing is not indicated—focus on aggressive medical therapy and risk factor modification. 3 If you have symptoms (chest pain, shortness of breath with exertion), functional testing or CT coronary angiography should be considered before any invasive procedures. 3
Follow-Up Recommendations
- Do not repeat calcium scoring sooner than 3-5 years, as progression tracking has limited utility when already on optimal medical therapy 4
- Annual cardiovascular risk assessment is appropriate 4
- Monitor medication adherence to ensure statin therapy compliance 4
Common Pitfall to Avoid
Do not dismiss this score even if traditional risk calculators suggest low risk. 4 The calcium score provides direct evidence of atherosclerosis that supersedes calculated risk estimates. A CACS of 220 definitively reclassifies you into a higher risk category requiring treatment. 1