Calcium Scoring Can Be Key to Heart Attack Prevention

Knowing the score can make a big difference when it comes to heart health.

During a recent virtual Lunch & Learn from the American Heart Association, Dr. Aswini Kumar, cardiologist at Mercy Fort Smith, discussed women’s heart health and how calcium scoring can help detect blockages. She also discussed lifestyle changes that can help boost heart health, especially during changes brought about by COVID-19.

Calcium scoring can be a lifesaver for those with risk factors such as high blood pressure, high cholesterol, diabetes, obesity and a family history of heart disease. It involves a noninvasive test that measures the level of calcium buildup – or plaque – in coronary arteries. Plaque is made up of fatty substances or LDL cholesterol and fibrin. The buildups may remain stable in the arteries but eventually they can become inflamed and rupture, forming a blood clot that can cause a heart attack.

“These plaques initially are soft, but then eventually they get calcified with the deposition of calcium phosphate,” Dr. Kumar said. “That’s exactly what we are looking for with a calcium score.”

Calcium scoring is performed with a CT scanner. The entire test takes 10-15 minutes, while the scan time is only 5-15 seconds, with low radiation.

Calcium scoring is recommended for men over age 40 and women over age 50 who have one or more cardiac risk factors. Those with a family history of heart disease could be urged to get the screening as young as age 30.

“The benefit to asymptomatic individuals between ages 40 and 75, and some less than 40 who have family history, is that it’s going to change the outcome and prevent a cardiac event,” Dr. Kumar said.

Assessing the Score

What does a calcium score mean for a patient? Dr. Kumar said the score helps doctors guide treatment and classify a patient’s risk for heart disease.

A calcium score will range from 0 to more than 400; the higher the number, the higher the risk for heart attack.

• 0 is normal.
• 1-99 is mild calcification/buildup.
• 100-400 is moderate buildup.
• 400+ is severe buildup.

“Say someone has borderline LDL (bad) cholesterol, then you’re deciding whether to try treatment or not,” Dr. Kumar explained. “If you have a calcium score that shows plaque buildup, then you’re more inclined to start them on a treatment.”

Treatment could begin with cholesterol-lowering medication in addition to heart-healthy lifestyle changes.

If your score is higher than 400, Dr. Kumar strongly recommends additional tests, including a stress test or nuclear imaging, which can further pinpoint the severity of blockages. An abnormal score means the patient would need to see a cardiologist.

A mild calcium score would call for changes to a patient’s diet and lifestyle, including more exercise and a heart-healthy diet. A moderate score might call for the same changes as well as adding a low-dose aspirin regimen and cholesterol medicine. If someone is asymptomatic and their calcium score comes back zero, then they are told to simply continue what they’re doing.

If a patient is not starting any treatment, a calcium scan can be done every five years, Dr. Kumar said. A primary care doctor can schedule a calcium scoring, as can a cardiologist.

For those experiencing symptoms such as chest pain or shortness of breath, calcium scoring is not the test to do. Dr. Kumar said a stress test or heart catherization would be recommended.

COVID and Risk Factors

A sedentary lifestyle can be a risk factor for heart disease, as can smoking and high levels of stress, Dr. Kumar said. And because of changes brought about by COVID-19, including more people working from home and fewer opportunities to engage in exercise, many people may see their risk of heart disease increase, Dr. Kumar said.

“One thing we tend to do when we’re working at home is snack quite a bit,” she said. “That’s something all my patients have told me in the past year. Try to watch what you’re eating, and every hour or so, if you’re working at a computer, go for a walk. Try to walk in your neighborhood, go to the gym or use equipment at home.

“The main thing is to stay active. Do some sort of activity and watch what you’re eating.”

Dr. Kumar recommends starting any exercise program slowly, then increasing what you’re able to do. She recommends at least 30 minutes of moderate-intensity exercise, such as walking, at least five times a week. She also urged people to eat more fruits and vegetables and a plant-based diet with limited red meat.

Dr. Kumar said she is also seeing patients experience more stress during COVID-19.

“Stress increases your heart risks,” she said. “That’s something common. Everybody’s having more stress with whatever is going on, including not being able to see family and not being able to go to social gatherings, which is the right thing to do amid the pandemic. But that puts extra stress on you and is not good for your mental or physical health.”

COVID-19 may also have had an impact on those with concerns about coming into a hospital setting. Dr. Kumar said some patients are putting off coming to the emergency room, even when they have heart attack symptoms.

“Time is crucial when it comes to heart attacks,” she said. “We would like to take someone to the cath lab as soon as possible, and when they present with symptoms a little bit late, they’re having some complications.”

Those who have had COVID and recovered may have concerns about their future heart health. Dr. Kumar said if someone had mild symptoms, they shouldn’t expect to have any serious heart problems related to COVID and should continue their heart-healthy lifestyle. If someone had more moderate to severe COVID symptoms, heart inflammation could be a concern. Dr. Kumar said decisions on treatment would be individualized for each patient and they should first talk with their primary care doctor.

Learn more about calcium scoring here.