Calcium Scores
What a Coronary Calcium Score Means for Your Heart
This article is part of our Doctor’s Insights series, where physicians share expert perspectives on important topics in cardiovascular medicine.
Coronary calcium scans have become an increasingly common diagnostic test in recent years, and many patients now ask about their calcium score during routine checkups. While the score can provide very useful information about heart disease risk, the results can sometimes also cause confusion or concern.
Ajay Kirtane, MD, an interventional cardiologist and director of Interventional Cardiovascular Care at Columbia University Irving Medical Center, says the key is understanding what the test can and cannot tell you about your heart.
“A calcium score is really a marker of risk,” Dr. Kirtane explains. “It tells us that plaque may be present in the coronary arteries, but it doesn’t necessarily mean something dangerous is about to happen soon.”
Who Should Get a Coronary Calcium Scan?
Despite the growing attention, the test is not necessary for everyone.
“Not everybody needs a calcium score,” Dr. Kirtane says. “If you’ve already had a stent, bypass surgery, or another condition like diabetes that already puts you at high cardiovascular risk, the test doesn’t add much because we already know you’re high risk.”
Instead, the test is most useful for people whose cardiovascular risk is uncertain – for example, someone with borderline cholesterol levels or a family history of heart disease, or other risk factors where the best prevention strategy is unclear.
“In those situations, the calcium score can help guide decision-making. It can tell us whether someone’s risk is higher than it appears based on traditional factors alone. It might also help to convince someone who is on the fence about taking medications for cholesterol.”
Calcium scores measure the amount of calcified plaque in the arteries that supply blood to the heart.
A High Calcium Score Doesn’t Mean a Heart Attack is About to Happen
One of the most common misconceptions patients have is that a high calcium score means they are about to experience a heart attack.
The test measures calcified plaque around the coronary arteries, which indicates the presence of atherosclerosis – a slow, progressive disease where plaque (which can contain fat, cholesterol, and calcium) builds up inside artery walls, causing them to narrow and stiffen – but does not predict exactly when or whether an event will occur.
“Many patients come in very worried when they see a high number,” Dr. Kirtane says. “But a calcium score is a marker of long-term risk, not a sign that you need an emergency procedure.”
For people without symptoms – such as chest pain or shortness of breath – the next step is usually not a procedure like a cardiac catheterization with an angiogram and possible stent. Instead, doctors focus on reducing cardiovascular risk through prevention.
That includes aggressively controlling cholesterol, maintaining healthy blood pressure, exercising regularly, avoiding smoking, and managing conditions such as diabetes.
“These strategies are highly effective at preventing cardiovascular events,” he says.
Why the Score Alone Doesn’t Tell the Whole Story
While the number itself often gets the most attention, cardiologists also consider other aspects of plaque that go beyond the score – like where the plaque is located and how dense it is.
“Calcium can appear in different arteries and in different patterns,” Dr. Kirtane explains. “In some cases, more dense calcium may actually reflect a chronic process that has been stable for a long time.”
The test also does not show whether plaque is located inside the artery obstructing blood flow or just along the vessel wall – details that can influence how cardiologists interpret the findings.
Because of this, cardiologists typically evaluate the calcium score alongside other factors, including symptoms, medical history, and overall cardiovascular risk.
Should Calcium Scores Be Repeated?
Another common question is whether calcium scoring should be repeated over time.
In many cases, repeating the test provides little additional value.
“If you’ve already had a calcium score and started treatment – such as cholesterol-lowering medication – you generally don’t need another scan,” Dr. Kirtane says.
That’s because medications like statins can actually increase the amount of calcium detected on the scan as plaques become more stable.
“The statin can make plaque more calcified and stable (which is a good thing). Cholesterol medications can raise the score without meaning your risk has increased,” he explains.
For this reason, the test is typically used as a decision-making tool at the start of prevention strategies, rather than something that needs to be tracked repeatedly.
What a Zero Calcium Score Really Means
At the other end of the spectrum, many patients assume that a calcium score of zero means they are completely free of heart disease. While a zero score is reassuring, it does not eliminate risk entirely.
“Patients sometimes joke and ask if a zero score means they can go eat whatever they want,” Dr. Kirtane says. “But it doesn’t actually mean your risk is zero.”
The test detects calcified plaque, but some patients may still have non-calcified plaque, which does not appear on the scan.
For people with strong family histories or other risk factors, aggressive prevention strategies may still be recommended even with a zero score.
A Tool for Prevention and Awareness
Ultimately, cardiologists see calcium scoring as a way to better understand cardiovascular risk and motivate preventive care.
“I think one of the biggest benefits of a calcium score is that it can motivate people to take their heart health seriously,” Dr. Kirtane says.
For patients who learn they have a higher risk of heart disease, the information can prompt meaningful lifestyle changes and better management of cholesterol, blood pressure, and other risk factors.
“When someone comes in worried about their calcium score, the most important thing is not to be afraid,” he says. “Instead, use that information as motivation to focus on prevention and long-term heart health.”
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