From the Guidelines
A coronary calcium score of 70% with a 96th percentile ranking indicates significant coronary artery calcification, suggesting moderate to advanced atherosclerosis, and necessitates aggressive management to reduce the risk of coronary events, as supported by recent studies such as 1 and 1. Given the high percentile ranking, it is crucial to initiate preventive measures promptly.
- Treatment should include daily aspirin (81mg) and a moderate to high-intensity statin like atorvastatin (20-80mg) or rosuvastatin (10-40mg), as suggested by guidelines 1.
- Lifestyle modifications are essential and should include adopting a heart-healthy Mediterranean or DASH diet, exercising regularly (150 minutes of moderate activity weekly), quitting smoking, limiting alcohol, and maintaining a healthy weight.
- Blood pressure should be controlled to below 130/80 mmHg, and if diabetes is present, tight glucose control should be maintained. The calcification represents atherosclerotic plaque buildup in the coronary arteries that has progressed to the point of calcification, which is why aggressive preventive measures are necessary to reduce the risk of heart attack or other cardiac events, as highlighted by studies such as 1 and 1. It is also important to note that a CAC score is a reliable marker of coronary atherosclerosis and vascular age, and its use can aid in improved risk stratification beyond conventional risk factor–based scores alone, as demonstrated by research 1. Therefore, consulting with a cardiologist promptly for a comprehensive evaluation is strongly recommended to tailor the management plan according to individual risk factors and health status.
From the Research
Coronary Calcification and Calcium Score
- A coronary calcification of 70% with a 96 percentile observed calcium score indicates a high level of coronary artery calcification (CAC) 2.
- CAC is associated with major adverse cardiovascular events and is a marker of atherosclerotic cardiovascular disease (ASCVD) 2, 3.
Risk Factors and Mechanisms
- CAC is more prevalent in men, older adults, Caucasians, individuals with diabetes, and those with chronic kidney disease 4, 2.
- The mechanism of vascular calcification is an active, regulated process, and several theories have been proposed to explain its development 2.
- CAC can be detected using coronary computed tomographic angiography, and measurement of CAC by scoring is a reasonable metric for cardiovascular risk assessment in asymptomatic adults at intermediate risk 2, 5.
Treatment and Progression
- Effective medical treatment of CAC has not been identified, and several strategies of percutaneous coronary intervention have been applied to patients with CAC, but with unsatisfactory results 2.
- Statin therapy has been shown to reduce the progression of coronary atheroma, but its effect on CAC is unclear 6, 3.
- Combination therapy with a PCSK9 inhibitor and a statin may reduce the annual rate of CAC progression compared to statin monotherapy 6.
- Long-term statin therapy has been associated with an increased likelihood of severe CAC, particularly in patients with significant smoking history 3.
Management and Monitoring
- Accurate evaluation of patient and lesion characteristics is crucial for planning the best percutaneous coronary intervention strategy in patients with CAC 4.
- Intracoronary imaging is useful and necessary to understand calcific lesion features and plan the best procedure before stenting and final optimization 4.
- Regular monitoring of CAC using coronary computed tomographic angiography may be necessary to assess the progression of CAC and adjust treatment strategies accordingly 2, 5, 6, 3.