Understanding Your Coronary Artery Calcium Score of 4
Your calcium score of 4 in the LAD artery indicates very early coronary atherosclerosis with minimal calcified plaque burden, placing you at low but not zero cardiovascular risk, and this finding warrants preventive medical therapy and lifestyle modifications rather than invasive procedures. 1, 2
What This Score Means
Your coronary artery calcium (CAC) score measures the amount of calcified plaque in your heart arteries. Here's what your score of 4 tells us:
Very minimal disease present: A score of 4 is in the lowest category of detectable calcium, indicating you have very early atherosclerosis (hardening of the arteries) 2, 3
Location matters: All your calcium is in the LAD (left anterior descending artery), which is the most common location for early calcium deposits to appear 3, 4, 5
Not zero, but very low: While a score of zero indicates excellent prognosis with less than 1% annual risk of heart attack, your score of 4 means you've crossed the threshold from "no detectable disease" to "minimal disease present" 1, 2
Good news: Scores this low (under 10) are associated with very low near-term cardiovascular event rates, but the presence of any calcium means you need preventive treatment 2, 3
What You Should Do Now
Aggressive preventive therapy is warranted, not invasive procedures:
Start or intensify statin therapy: Your doctor should prescribe a statin medication to lower your LDL cholesterol aggressively, as even minimal calcium scores indicate you will benefit from cholesterol-lowering therapy 2
Blood pressure control: If you have hypertension, strict blood pressure control is essential (target <130/80 mmHg) 4, 5
Diabetes management: If you have diabetes, optimal glucose control is critical, as diabetes is associated with higher calcium scores and faster progression 4, 5
Lifestyle modifications:
Consider aspirin: Discuss with your doctor whether daily low-dose aspirin is appropriate for you 2
What This Does NOT Mean
You do not need cardiac catheterization or stenting - a score of 4 does not indicate blockages requiring procedures 1, 2
This is not an emergency - your risk of a heart attack in the next 5 years remains very low with proper treatment 1, 2
Important caveat: The calcium score only detects calcified plaque. You could have non-calcified ("soft") plaque that doesn't show up on this test, which is why preventive treatment is still important even with a low score 1, 6
Follow-Up and Monitoring
Repeat calcium scoring is generally not recommended in the near term, as changes take years to develop 3
If you develop chest pain or other cardiac symptoms, you may need additional testing such as a stress test or CT angiography to look for blockages, regardless of your low calcium score 7, 6
Annual check-ups with your primary care doctor to monitor cholesterol, blood pressure, and other risk factors 2
The Bottom Line
Think of your score of 4 as an early warning system that caught disease at its earliest stage. With proper preventive treatment starting now, you can slow or potentially stop progression of this early atherosclerosis and maintain your low cardiovascular risk. 2, 3