Coronary Calcium Scans: Know the Score!

When Coronary Artery CT Calcium scans first came out, there was the thought that it’s a gimmick to keep underemployed radiologists busy. However, as time went on, studies accumulated, techniques improved and folks began to realize that it was a pretty good tool to estimate risk of coronary problems before they become problems. A Coronary Artery Calcium (CAC) scan is a type of computerized tomography of the heart. Computerized tomography (CT) is a slick computer assisted type of x-ray imaging that takes radiographic slices of whatever is being scanned, allowing a much higher degree of precision than a plain old x-ray. They first started doing CT scans on the coronary arteries of the heart back in 1990 and over the years found that asymptomatic people with lots of calcium in their coronaries did indeed often go on to develop symptomatic coronary artery heart disease with chest pain on exertion (angina) and heart attacks. So how do coronary arteries get calcified? It all begins when high amounts of cholesterol get deposited in the coronaries. These build up to form plaques which can obstruct blood flow to the muscle of the heart. Bad stuff! As plaques age, they start to pick up calcium which shows up on x-ray. So that’s the drawback of CAC scans. They don’t pick up early, non-calcified plaques that can cause trouble in the coronaries. Nevertheless, if you have a lot of calcium in the coronary arteries of your heart, you are definitely at increased risk of a heart attack or stroke.

So why would you think of getting a Coronary Artery CT Calcium scan? If you do have a history of heart disease in the family that would be a good reason. If you have diabetes or any other disease that predisposes to arterial problems that’s another good reason. Overweight and a sedentary lifestyle are also risk factors. If you’re nuts enough to smoke, that’s a big risk factor. Also, some folks just want to be sure.

If you have a scan, you’ll get a report with either an Agaston Score (0 to 4) or a CAC (Coronary Artery Calcification Score of 0 to >400). Here’s how they break down:

A 0 or CAC 0: Very low risk. Unless you have a rare familial disorder of cholesterol metabolism, no treatment is recommended.

A1 or CAC 1-99: Mildly increased risk. Perhaps starting a cholesterol lowering statin would be good.

A2 or CAC 100-299: Moderately increased risk. Usually, aggressive statin therapy is recommended.

A3 or CAC 300-400: Moderately to severely increased risk. Statins plus aspirin 81 mg is usually recommended.

A4 of CAC >400: Severely increased risk. Statins and aspirin and maybe some extra studies would be in order.

Also, if your CAC score is greater than 400, the FAA is going to get excited. It is with good reason, as a score this high is associated with a 5% event rate per year. In other words, there’s a 1 in 20 chance you’ll have a heart attack or stroke every year you are walking around with those calcium ladened crunchy coronaries! They definitely will want to see more extensive testing of your coronary arteries to see what’s going on and what can be done to correct it. As a matter of fact, you should too.

Fly wisely. See you next month.

As always, comments, questions and suggestions are welcome: jdlakinmd@gmail.com.

Also, we’ve moved our office to Airlake Airport’s FBO (KLVN). Call 952-469-4414 or

info@aloft-aviation.com for a flight physical appointment.